1598834624 NPI number — MR. ALDEN RALPH GARDNER SR. PSYCH EXAMINER

Table of content: MR. ALDEN RALPH GARDNER SR. PSYCH EXAMINER (NPI 1598834624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598834624 NPI number — MR. ALDEN RALPH GARDNER SR. PSYCH EXAMINER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
ALDEN
Provider Middle Name:
RALPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SR. PSYCH EXAMINER
Provider Gender Code:
M

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:
1598834624
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:
1901 W CLINCH AVE
Provider Second Line Business Mailing Address:
PATRICIA NEAL REHABILITATION CENTER
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37916-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-541-1699
Provider Business Mailing Address Fax Number:
865-541-4909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 W CLINCH AVE
Provider Second Line Business Practice Location Address:
PATRICIA NEAL REHABILITATION CENTER
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-541-1699
Provider Business Practice Location Address Fax Number:
865-541-4909
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PE 0000000032 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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