1144243296 NPI number — DR. BRIGETTE BAILEY RABITSCH O.D.

Table of content: DR. BRIGETTE BAILEY RABITSCH O.D. (NPI 1144243296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144243296 NPI number — DR. BRIGETTE BAILEY RABITSCH O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RABITSCH
Provider First Name:
BRIGETTE
Provider Middle Name:
BAILEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILEY
Provider Other First Name:
BRIGETTE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144243296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
771 OLD NORCROSS RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-4386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-995-5408
Provider Business Mailing Address Fax Number:
770-513-2042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
771 OLD NORCROSS RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30046-4979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-995-5408
Provider Business Practice Location Address Fax Number:
770-513-2042
Provider Enumeration Date:
07/26/2006

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: 152W00000X , with the licence number:  2167 , 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: P00340944 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".