1467638098 NPI number — ATLANTA ARTHRITIS CENTER, P.C.

Table of content: (NPI 1467638098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467638098 NPI number — ATLANTA ARTHRITIS CENTER, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA ARTHRITIS CENTER, P.C.
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:
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:
1467638098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 HEMBREE RD.
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-3810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-867-0000
Provider Business Mailing Address Fax Number:
678-867-0003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 HEMBREE RD.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-867-0000
Provider Business Practice Location Address Fax Number:
678-867-0003
Provider Enumeration Date:
01/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMITHERMAN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
LANCE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
678-867-0000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  045973 , 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: 52598444003 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000809465D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3405853 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 5700685 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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