1386895324 NPI number — THE POTTERS HOUSE FAMILY AND CHILDREN TREATMENT CENTER

Table of content: KRISTEN JEAN ANGLE FNP (NPI 1881218477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386895324 NPI number — THE POTTERS HOUSE FAMILY AND CHILDREN TREATMENT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE POTTERS HOUSE FAMILY AND CHILDREN TREATMENT CENTER
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:
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:
1386895324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1899 PARKER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STONE MOUNTAIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30087-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-987-1020
Provider Business Mailing Address Fax Number:
678-987-1019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1899 PARKER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONE MOUNTAIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30087-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-987-1020
Provider Business Practice Location Address Fax Number:
678-987-1019
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
MARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
678-987-1020

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  LPC005074 , 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)





Copyright © 2007-2025 www.npivalidator.com