1447973011 NPI number — MARY CAPERS ELDER WICKER PA

Table of content: MARY CAPERS ELDER WICKER PA (NPI 1447973011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447973011 NPI number — MARY CAPERS ELDER WICKER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WICKER
Provider First Name:
MARY CAPERS
Provider Middle Name:
ELDER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELDER
Provider Other First Name:
MARY
Provider Other Middle Name:
CAPERS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447973011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
691 14TH ST NW UNIT 511
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-5620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-260-0199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
712 THOMAS GLEN CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37069-4013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-260-0199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2022

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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