1417910431 NPI number — ATLANTA CENTER FOR DERMATOLOGIC DISEASES PC

Table of content: (NPI 1417910431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417910431 NPI number — ATLANTA CENTER FOR DERMATOLOGIC DISEASES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA CENTER FOR DERMATOLOGIC DISEASES PC
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:
DRS D LEVINE J SILYERSTEIN M FISHER M WEIL K ELLNER
Provider Other Organization Name Type Code:
5
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:
1417910431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1265 UPPER HEMBREE RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-751-1433
Provider Business Mailing Address Fax Number:
770-751-7410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 UPPER HEMBREE RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-751-1433
Provider Business Practice Location Address Fax Number:
770-751-7410
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REINER
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
BOOKKEEPING INSURANCE
Authorized Official Telephone Number:
770-751-1433

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  027080 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 032990 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207N00000X , with the licence number: 034135 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 044141 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 032377 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D45942 . This is a "PRUCARE SELECT" identifier . This identifiers is of the category "OTHER".
  • Identifier: D45942 . This is a "PRUDENTIAL HMD AFFILIAT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 237691 . This is a "STATE OF GEORGIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 045942 . This is a "FAMILY PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 237691 . This is a "BCBS BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 472244 . This is a "AETNA US HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CM0095 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104004 . This is a "HMO PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 070004931 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0306784 . This is a "HMO HEALTH FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 077541037 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: D45942 . This is a "PRUCARE PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: D45942 . This is a "EMORY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1751 . This is a "HMO GEORGIA NETWORK" identifier . This identifiers is of the category "OTHER".




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