1487690871 NPI number — MRS. CYNTHIA ADKINSON ALYEA P.T.

Table of content: MRS. CYNTHIA ADKINSON ALYEA P.T. (NPI 1487690871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487690871 NPI number — MRS. CYNTHIA ADKINSON ALYEA P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALYEA
Provider First Name:
CYNTHIA
Provider Middle Name:
ADKINSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAEGER
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ADKINSON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487690871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 TOWER ROAD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-9403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-218-0219
Provider Business Mailing Address Fax Number:
770-514-6744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 STONE BRIDGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30189-8252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-926-6520
Provider Business Practice Location Address Fax Number:
770-926-1359
Provider Enumeration Date:
06/22/2006

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: 2251X0800X , with the licence number:  PT000926 , 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: 52197989003 . This is a "BCBS DOUGLASVILLE LOCATIO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52197989001 . This is a "BCBS WOODSTOCK LOCATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52197989002 . This is a "BCBS AUSTELL LOCATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52197989004 . This is a "BCBS MARIETTA LOCATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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