1215487962 NPI number — TALBOTT COLUMBUS

Table of content: DAVID NORVAL KINGSLEY M.D. (NPI 1366452344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215487962 NPI number — TALBOTT COLUMBUS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TALBOTT COLUMBUS
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:
1215487962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49501-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-251-3211
Provider Business Mailing Address Fax Number:
770-970-2195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 BROOKSTONE CENTRE PKWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-2988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-251-3211
Provider Business Practice Location Address Fax Number:
770-970-2195
Provider Enumeration Date:
10/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP - CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
610-382-3319

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  106094D , 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)