1558439752 NPI number — WILLIAM C BYRD OF TURNER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558439752 NPI number — WILLIAM C BYRD OF TURNER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM C BYRD OF TURNER INC
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:
GOLDEN SOUTH II
Provider Other Organization Name Type Code:
3
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:
1558439752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 890
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIFTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-382-8655
Provider Business Mailing Address Fax Number:
229-382-7011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 DENHAM ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-567-4273
Provider Business Practice Location Address Fax Number:
229-567-2138
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
229-382-8655

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , 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: 00768248C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com