1447771738 NPI number — SALINA CLARECE CRAYTON MS, LAT, ATC

Table of content: SALINA CLARECE CRAYTON MS, LAT, ATC (NPI 1447771738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447771738 NPI number — SALINA CLARECE CRAYTON MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAYTON
Provider First Name:
SALINA
Provider Middle Name:
CLARECE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIOP
Provider Other First Name:
SALINA
Provider Other Middle Name:
CLARECE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LAT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447771738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5448 JANET LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30106-7919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-471-2088
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 COBB PKWY N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30062-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-471-2088
Provider Business Practice Location Address Fax Number:
678-471-2088
Provider Enumeration Date:
06/27/2017

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: 2255A2300X , with the licence number:  AT000804 , 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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