1609048792 NPI number — ARROWHEAD OPERATOR LLC

Table of content: DR. ANNA AGNIESZKA KRASZEWSKA MD (NPI 1538237938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609048792 NPI number — ARROWHEAD OPERATOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARROWHEAD OPERATOR LLC
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:
1609048792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
239 ARROWHEAD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30236-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-478-3013
Provider Business Mailing Address Fax Number:
770-478-3446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 ARROWHEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-478-3013
Provider Business Practice Location Address Fax Number:
770-478-3446
Provider Enumeration Date:
03/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
KIMNIE
Authorized Official Middle Name:
CHAN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
770-478-3013

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1-031-1409 , 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: 000143162A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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