1437354396 NPI number — MS. SUSAN RACHELLE WINFIELD L.P.C.

Table of content: MS. SUSAN RACHELLE WINFIELD L.P.C. (NPI 1437354396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437354396 NPI number — MS. SUSAN RACHELLE WINFIELD L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINFIELD
Provider First Name:
SUSAN
Provider Middle Name:
RACHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINFIELD
Provider Other First Name:
CANDEE'
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.P.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437354396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1044 BRIARBERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30296-7102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-305-8175
Provider Business Mailing Address Fax Number:
404-305-8176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 PHOENIX BLVD
Provider Second Line Business Practice Location Address:
SUITE 540
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-5594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-909-9500
Provider Business Practice Location Address Fax Number:
770-909-9600
Provider Enumeration Date:
06/19/2007

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: 101YP2500X , with the licence number:  LPC002594 , 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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