1336398726 NPI number — MRS. ROBIN DOMM BURCH NNP-BC

Table of content: MRS. ROBIN DOMM BURCH NNP-BC (NPI 1336398726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336398726 NPI number — MRS. ROBIN DOMM BURCH NNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURCH
Provider First Name:
ROBIN
Provider Middle Name:
DOMM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOMM
Provider Other First Name:
ROBIN
Provider Other Middle Name:
BARBARA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336398726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1790 MULKEY ROAD STE 10 BLDG 10
Provider Second Line Business Mailing Address:
NEWBORN CLINICS OF AMERICA LLC AT WELLSTAR COBB CLINIC
Provider Business Mailing Address City Name:
AUSTELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-606-0154
Provider Business Mailing Address Fax Number:
678-615-2107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1790 MULKEY RD STE 10
Provider Second Line Business Practice Location Address:
NEWBORN CLINICS OF AMERICA LLC AT WELLSTAR COBB CLINIC
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30106-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-606-0151
Provider Business Practice Location Address Fax Number:
770-392-0180
Provider Enumeration Date:
09/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  RN065363 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 624183405A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com