1326261835 NPI number — ELEANOR COCHRANE SULLIVAN CPNP

Table of content: ELEANOR COCHRANE SULLIVAN CPNP (NPI 1326261835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326261835 NPI number — ELEANOR COCHRANE SULLIVAN CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
ELEANOR
Provider Middle Name:
COCHRANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
PATTIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326261835
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 LAKE HEARN DR NE STE 100
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:
30342-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-256-3178
Provider Business Mailing Address Fax Number:
404-256-3583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 LAKE HEARN DR NE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-256-3178
Provider Business Practice Location Address Fax Number:
404-256-3583
Provider Enumeration Date:
04/11/2007

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: 363LP0200X , with the licence number:  RN073627NP , 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)





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