1083200497 NPI number — MERCI HEALTHCARE SERVICES LLC

Table of content: ANTONIO MERRETT WOMACK MS (NPI 1578881843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083200497 NPI number — MERCI HEALTHCARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCI HEALTHCARE SERVICES 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:
1083200497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 VILLAGE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30265-5708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-332-8175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 VILLAGE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-5708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-332-8175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DIYOMBI
Authorized Official First Name:
KARENA
Authorized Official Middle Name:
SPELLER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
706-332-8175

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHCP010909 . This is a "PRIVATE HOMECARE PROVIDER PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com