1508534942 NPI number — CATALINA FREIGHT CORP

Table of content: MS. VIJAY SHRI KANNAN M.D. (NPI 1942295621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508534942 NPI number — CATALINA FREIGHT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATALINA FREIGHT CORP
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:
6
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:
1508534942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2762 GROOVERS LAKE PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHIA SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30122-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-848-0859
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2762 GROOVERS LAKE PT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHIA SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30122-2486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-848-0859
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
TOEY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
470-848-0859

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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