1326226861 NPI number — DR. ROSALIND M MANCE M.D, MBBS

Table of content: DR. ROSALIND M MANCE M.D, MBBS (NPI 1326226861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326226861 NPI number — DR. ROSALIND M MANCE M.D, MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANCE
Provider First Name:
ROSALIND
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D, MBBS
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:
1326226861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1428 BENNING PL NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30307-1624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-577-9082
Provider Business Mailing Address Fax Number:
404-577-1828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 E PONCE DE LEON AVE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30030-2543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-577-9082
Provider Business Practice Location Address Fax Number:
404-577-1828
Provider Enumeration Date:
02/06/2008

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: 2084P0800X , with the licence number:  22095 , 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: 00296986A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com