1063699015 NPI number — JOHN M DOWNEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063699015 NPI number — JOHN M DOWNEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN M DOWNEY
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:
1063699015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2922 PROFESSIONAL PKWY
Provider Second Line Business Mailing Address:
PO BOX 212959
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30907-6528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-855-2767
Provider Business Mailing Address Fax Number:
706-855-7077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2922 PROFESSIONAL PKWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30907-6528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-855-2767
Provider Business Practice Location Address Fax Number:
706-855-7077
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DOWNEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-855-2767

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  031411 , 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: 00458224A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1083607-066 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: G31411 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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