1962735654 NPI number — SINDI S BENNETT PAAA

Table of content: SINDI S BENNETT PAAA (NPI 1962735654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962735654 NPI number — SINDI S BENNETT PAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
SINDI
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEPPARD
Provider Other First Name:
SINDI
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962735654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3155 N POINT PKWY
Provider Second Line Business Mailing Address:
BUILDING F, SUITE 100
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-645-9181
Provider Business Mailing Address Fax Number:
770-645-8455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 JOHNSON FERRY RD 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:
30342-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-645-9181
Provider Business Practice Location Address Fax Number:
770-645-8455
Provider Enumeration Date:
09/12/2009

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: 367H00000X , with the licence number:  005651 , 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)