1588737175 NPI number — MRS. LINDA DIANE MARTIN TERRELL RN PHN

Table of content: MRS. LINDA DIANE MARTIN TERRELL RN PHN (NPI 1588737175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588737175 NPI number — MRS. LINDA DIANE MARTIN TERRELL RN PHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN TERRELL
Provider First Name:
LINDA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN PHN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN TERRELL
Provider Other First Name:
LINDA
Provider Other Middle Name:
GRIMES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN PHN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588737175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 JESSE HILL JR DRIVE SE
Provider Second Line Business Mailing Address:
ROOM 402
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 BOULEVARD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-730-1668
Provider Business Practice Location Address Fax Number:
404-730-1680
Provider Enumeration Date:
11/15/2006

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: 163W00000X , with the licence number:  R097800 , 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)