1114177722 NPI number — MALACHI HUTTO III P.A.

Table of content: MALACHI HUTTO III P.A. (NPI 1114177722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114177722 NPI number — MALACHI HUTTO III P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTTO
Provider First Name:
MALACHI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
P.A.
Provider Gender Code:
M

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:
1114177722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300A MANCHESTER EXPRESS WAY SUITE 101A
Provider Second Line Business Mailing Address:
ST. FRANCIS ORTHOPAEDIC INSTITUTE
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-322-6646
Provider Business Mailing Address Fax Number:
706-322-2891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300A MANCHESTER EXPRESS WAY SUITE 101A
Provider Second Line Business Practice Location Address:
ST. FRANCIS ORTHOPAEDIC INSTITUTE
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-322-6646
Provider Business Practice Location Address Fax Number:
706-322-2891
Provider Enumeration Date:
09/19/2008

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: 363AS0400X , with the licence number:  005420 , 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)





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