1053598151 NPI number — BRIAN K. NADOLNE, MD, PC

Table of content: (NPI 1053598151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053598151 NPI number — BRIAN K. NADOLNE, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN K. NADOLNE, MD, 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:
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:
1053598151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 JOHNSON FERRY PL STE H20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30068-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-509-0017
Provider Business Mailing Address Fax Number:
770-971-7818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 JOHNSON FERRY PL STE H20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30068-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-509-0017
Provider Business Practice Location Address Fax Number:
770-971-7818
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NADOLNE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-509-0017

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  040748 , 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: 7394560 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00739505E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00243653 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1073451 . This is a "COVENTRY HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 176614008 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52543664 . This is a "B/C B/S OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5656896 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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