1992852750 NPI number — CLAIRE M WHEELER PH.D.

Table of content: BRITTANY GRANGER (NPI 1164962643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992852750 NPI number — CLAIRE M WHEELER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
CLAIRE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1992852750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SKYLINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30204-1810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-584-2128
Provider Business Mailing Address Fax Number:
770-358-1015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
526 COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30204-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-584-2128
Provider Business Practice Location Address Fax Number:
770-358-1015
Provider Enumeration Date:
01/04/2007

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: 103T00000X , with the licence number:  1275 , 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: 000572976C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".