1376565887 NPI number — CHRISTINA ZANE LUCZYNSKI AU.D.

Table of content: CHRISTINA ZANE LUCZYNSKI AU.D. (NPI 1376565887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376565887 NPI number — CHRISTINA ZANE LUCZYNSKI AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCZYNSKI
Provider First Name:
CHRISTINA
Provider Middle Name:
ZANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZANE
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.C.D., CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376565887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 100A
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-9075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-474-7416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-9075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-474-7416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006

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: 231H00000X , with the licence number:  AUD003687 , 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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