1326084278 NPI number — TENET SOUTH FULTON INC.

Table of content: (NPI 1326084278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326084278 NPI number — TENET SOUTH FULTON INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENET SOUTH FULTON INC.
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:
SOUTH FULTON PRIMARY CARE SERVICES
Provider Other Organization Name Type Code:
3
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:
1326084278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 JOHN WESLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30337-3606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-765-4164
Provider Business Mailing Address Fax Number:
404-762-4897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3699 BAKERS FERRY RD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30331-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-765-4164
Provider Business Practice Location Address Fax Number:
404-762-4897
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
REGIONAL CFO, TENET
Authorized Official Telephone Number:
404-265-5009

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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