1417240490 NPI number — GEORGIA DEPARTMENT OF PUBLIC HEALTH

Table of content: (NPI 1417240490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417240490 NPI number — GEORGIA DEPARTMENT OF PUBLIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA DEPARTMENT OF PUBLIC HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GEORGIA PUBLIC HEALTH LABORATORY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417240490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PEACHTREE STREET NW
Provider Second Line Business Mailing Address:
15TH FLOOR
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303-3142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-657-2700
Provider Business Mailing Address Fax Number:
404-657-2715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1749 CLAIRMONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-4005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-327-7900
Provider Business Practice Location Address Fax Number:
404-327-7919
Provider Enumeration Date:
05/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FITZGERALD
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
COMMISSIONER
Authorized Official Telephone Number:
404-657-2700

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  044-121 , 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)





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