1275559452 NPI number — ATLANTA HYPERBARIC & WOUND CARE CLINIC, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275559452 NPI number — ATLANTA HYPERBARIC & WOUND CARE CLINIC, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA HYPERBARIC & WOUND CARE CLINIC, L.L.C.
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:
1275559452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2675 N DECATUR RD
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30033-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-501-7316
Provider Business Mailing Address Fax Number:
404-501-7319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2675 N DECATUR RD
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-501-7316
Provider Business Practice Location Address Fax Number:
404-501-7319
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOODHART
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN/ OWNER
Authorized Official Telephone Number:
404-501-7316

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  044154 , 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: 49-05588 . This is a "UNITED FACILITY ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00861682A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51004393 . This is a "STATE HEALTH BENEFIT ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 51004393 . This is a "BCBS FACILITY ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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