1487049565 NPI number — NINA DURCHFORT METCALFE M.D., M.S.

Table of content: NINA DURCHFORT METCALFE M.D., M.S. (NPI 1487049565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487049565 NPI number — NINA DURCHFORT METCALFE M.D., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METCALFE
Provider First Name:
NINA
Provider Middle Name:
DURCHFORT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.S.
Provider Gender Code:
F

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:
1487049565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1551 JANMAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30078-5606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-344-8900
Provider Business Mailing Address Fax Number:
678-691-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 PEACHTREE ST NW STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-344-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2015

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: 207VF0040X , with the licence number:  83208 , 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)