1881879559 NPI number — JERALD N KRAMER DPM PC

Table of content: (NPI 1881879559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881879559 NPI number — JERALD N KRAMER DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERALD N KRAMER DPM 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:
PODIATRIC SURGICENTER
Provider Other Organization Name Type Code:
3
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:
1881879559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 CLAIREMONT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30030-2505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-373-2529
Provider Business Mailing Address Fax Number:
404-373-1655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 CLAIREMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30030-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-373-2529
Provider Business Practice Location Address Fax Number:
404-373-1655
Provider Enumeration Date:
12/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
JERALD
Authorized Official Middle Name:
N
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
404-373-2529

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  044-074 , 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: 00561657A . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 111050ASCA . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881879559 . This is a "PODIATRIC SURGICENTER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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