1528033982 NPI number — ALISON N COLQUITT AAPA

Table of content: ALISON N COLQUITT AAPA (NPI 1528033982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528033982 NPI number — ALISON N COLQUITT AAPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLQUITT
Provider First Name:
ALISON
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AAPA
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:
1528033982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1078
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30012-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-388-7745
Provider Business Mailing Address Fax Number:
770-922-0526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1359 MILSTEAD RD NE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30012-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-388-7745
Provider Business Practice Location Address Fax Number:
770-922-0526
Provider Enumeration Date:
02/21/2006

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: 367H00000X , with the licence number:  003505 , 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: 100001305A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com