1235517137 NPI number — MRS. NATALIE BESSOM

Table of content: MRS. NATALIE BESSOM (NPI 1235517137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235517137 NPI number — MRS. NATALIE BESSOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BESSOM
Provider First Name:
NATALIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOGAN
Provider Other First Name:
NATALIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235517137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 MEMORIAL DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30720-8662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-226-9355
Provider Business Mailing Address Fax Number:
706-226-9380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 MEMORIAL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-226-9355
Provider Business Practice Location Address Fax Number:
706-226-9380
Provider Enumeration Date:
05/12/2015

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: 207Q00000X , with the licence number:  OT016323 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 080343 , 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)