1396898144 NPI number — TERRI MORTON ACKER

Table of content: TERRI MORTON ACKER (NPI 1396898144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396898144 NPI number — TERRI MORTON ACKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORTON ACKER
Provider First Name:
TERRI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1396898144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3546 COVINGTON HWY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30032-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-284-7744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3546 COVINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30032-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-284-7744
Provider Business Practice Location Address Fax Number:
404-284-8006
Provider Enumeration Date:
01/18/2007

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: 207Q00000X , with the licence number:  047791 , 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: 317910 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000778016C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00231885 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000778016C . This is a "PEACHSTATE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 610247700 . This is a "WORKER COMP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 10046542 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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