1013963024 NPI number — MRS. CLAUDIA VICTORIA CANO JOHNSON N.P.

Table of content: MRS. CLAUDIA VICTORIA CANO JOHNSON N.P. (NPI 1013963024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013963024 NPI number — MRS. CLAUDIA VICTORIA CANO JOHNSON N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANO JOHNSON
Provider First Name:
CLAUDIA
Provider Middle Name:
VICTORIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1013963024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1639 ACADEMY SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30337-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-766-2949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2739 FELTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-766-8371
Provider Business Practice Location Address Fax Number:
404-767-3926
Provider Enumeration Date:
05/25/2006

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: 363LW0102X , with the licence number:  RN135756 , 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: 000972727A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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