1942355342 NPI number — LEYLA EL-CHOUFI M.D.

Table of content: LEYLA EL-CHOUFI M.D. (NPI 1942355342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942355342 NPI number — LEYLA EL-CHOUFI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL-CHOUFI
Provider First Name:
LEYLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1942355342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1705
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:
30903-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-774-7760
Provider Business Mailing Address Fax Number:
706-774-7766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 DANTIGNAC ST
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-2775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-774-7760
Provider Business Practice Location Address Fax Number:
706-774-7766
Provider Enumeration Date:
01/24/2007

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: 207RE0101X , with the licence number:  MD16530 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 46594 , 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: 00855181A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110201975 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: TL5840 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11D0687551 . This is a "GROUP CLIA NUMBER" identifier . This identifiers is of the category "OTHER".




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