1467547521 NPI number — DUBLIN HEMATOLOGY ONCOLOGY CARE, PC

Table of content: (NPI 1467547521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467547521 NPI number — DUBLIN HEMATOLOGY ONCOLOGY CARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBLIN HEMATOLOGY ONCOLOGY CARE, PC
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:
Provider Other Organization Name Type Code:
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:
1467547521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 FAIRVIEW PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31021-2550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-275-1111
Provider Business Mailing Address Fax Number:
478-275-1191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 FAIRVIEW PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-275-1111
Provider Business Practice Location Address Fax Number:
478-275-1191
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QAZI
Authorized Official First Name:
FARID
Authorized Official Middle Name:
U.
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
478-275-1111

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35737 , 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: 00530857Y , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010615 . This is a "STATE HEALTH BENEFIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00171973 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 010615 . This is a "BCGSGA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5053830001 . This is a "DMERC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 324423 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 83BBBRF . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: GRP4933 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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