1356450209 NPI number — MRS. BARI F LEVENS AUD, CCC-A

Table of content: MRS. BARI F LEVENS AUD, CCC-A (NPI 1356450209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356450209 NPI number — MRS. BARI F LEVENS AUD, CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVENS
Provider First Name:
BARI
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AUD, CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIEDBERG
Provider Other First Name:
BARI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD, CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356450209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 NORTH BELAIR ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-868-5676
Provider Business Mailing Address Fax Number:
706-722-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1303 DANTIGNAC STREET
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-868-5676
Provider Business Practice Location Address Fax Number:
706-722-2824
Provider Enumeration Date:
08/30/2006

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: 225000000X , with the licence number:  AUD003739 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AUD0003739 , 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: 7060018218 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 373758 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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