1275973315 NPI number — GEORGIA AMEIA YEN-PATTON GNP-BC, PHD

Table of content: GEORGIA AMEIA YEN-PATTON GNP-BC, PHD (NPI 1275973315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275973315 NPI number — GEORGIA AMEIA YEN-PATTON GNP-BC, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEN-PATTON
Provider First Name:
GEORGIA
Provider Middle Name:
AMEIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GNP-BC, PHD
Provider Gender Code:
F

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:
1275973315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14121 PARKE LONG CT
Provider Second Line Business Mailing Address:
SUITES 200 & 201
Provider Business Mailing Address City Name:
CHANTILLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20151-1647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-512-7287
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14121 PARKE LONG CT
Provider Second Line Business Practice Location Address:
SUITES 200 & 201
Provider Business Practice Location Address City Name:
CHANTILLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20151-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-512-7287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2013

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: 363LG0600X , with the licence number:  167529 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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