1245446483 NPI number — DR. NIMALIE DESILVA STONE M.D.

Table of content: DR. NIMALIE DESILVA STONE M.D. (NPI 1245446483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245446483 NPI number — DR. NIMALIE DESILVA STONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STONE
Provider First Name:
NIMALIE
Provider Middle Name:
DESILVA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESILVA
Provider Other First Name:
NIMALIE
Provider Other Middle Name:
INDHIRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245446483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1841 CLIFTON RD NE
Provider Second Line Business Mailing Address:
WESLEY WOODS HEALTH CENTER, ROOM 527
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30329-4021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-728-6317
Provider Business Mailing Address Fax Number:
404-728-6425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1841 CLIFTON RD NE
Provider Second Line Business Practice Location Address:
WESLEY WOODS HOSPITAL
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30329-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-728-6200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007

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: 207RI0200X , with the licence number:  054675 , 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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