1528006608 NPI number — BRANDIE KINNEY NOBLE MSPT

Table of content: BRANDIE KINNEY NOBLE MSPT (NPI 1528006608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528006608 NPI number — BRANDIE KINNEY NOBLE MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOBLE
Provider First Name:
BRANDIE
Provider Middle Name:
KINNEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KINNEY
Provider Other First Name:
BRANDIE
Provider Other Middle Name:
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:
1528006608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 CIRCLE 75 PKWY SE
Provider Second Line Business Mailing Address:
SUITE 1700
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-953-6929
Provider Business Mailing Address Fax Number:
770-953-6972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5205 STILESBORO RD NW
Provider Second Line Business Practice Location Address:
BUILDING II, SUITE 200
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30152-7764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-218-8800
Provider Business Practice Location Address Fax Number:
770-218-8811
Provider Enumeration Date:
06/02/2006

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: 225100000X , with the licence number:  PT8286 , 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: 345587121A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390126 . This is a "BCBSGA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 345587121B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".