1073971313 NPI number — RISE ABOVE IT LLC

Table of content: DR. TYLER RAE BROWN ND (NPI 1356216485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073971313 NPI number — RISE ABOVE IT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RISE ABOVE IT LLC
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:
1073971313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30133-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 AUSTELL POWDER SPRINGS RD
Provider Second Line Business Practice Location Address:
STE. 286
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30106-2427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-313-1773
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAY
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
770-313-1773

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  004926 , 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)