1619275534 NPI number — MONIQUE NICOLE BATCHELOR O. D.

Table of content: MONIQUE NICOLE BATCHELOR O. D. (NPI 1619275534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619275534 NPI number — MONIQUE NICOLE BATCHELOR O. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATCHELOR
Provider First Name:
MONIQUE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O. D.
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:
1619275534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4735 JONESBORO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30291-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-969-5976
Provider Business Mailing Address Fax Number:
770-969-6140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4002 STONE MOUNTAIN HWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30039-3977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-985-2666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2011

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: 152W00000X , with the licence number:  OPT002626 , 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)