1275055394 NPI number — ASHLEY VANLANDINGHAM PLATZER PA-C

Table of content: ASHLEY VANLANDINGHAM PLATZER PA-C (NPI 1275055394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275055394 NPI number — ASHLEY VANLANDINGHAM PLATZER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLATZER
Provider First Name:
ASHLEY
Provider Middle Name:
VANLANDINGHAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VANLANDINGHAM
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
VIRGINIA
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:
1275055394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1949 GUNBARREL RD STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37421-7133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-495-4345
Provider Business Mailing Address Fax Number:
423-495-4934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 WALMART DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SODDY DAISY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37379-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-332-6155
Provider Business Practice Location Address Fax Number:
423-332-5293
Provider Enumeration Date:
07/11/2017

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: 363A00000X , with the licence number:  3648 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com