1659623502 NPI number — MS. DANA LEAH GREEAR MS, RD, LD, MPH

Table of content: MS. DANA LEAH GREEAR MS, RD, LD, MPH (NPI 1659623502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659623502 NPI number — MS. DANA LEAH GREEAR MS, RD, LD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEAR
Provider First Name:
DANA
Provider Middle Name:
LEAH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, LD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEAR
Provider Other First Name:
DANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, LD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659623502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 13TH ST STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901-2771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-434-1590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 13TH ST
Provider Second Line Business Practice Location Address:
SUITE 10 POB 3
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-434-1590
Provider Business Practice Location Address Fax Number:
803-279-6001
Provider Enumeration Date:
10/02/2012

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: 133V00000X , with the licence number:  LD003947 , 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)





Copyright © 2007-2024 www.npivalidator.com