1669539508 NPI number — THE HEALTHCARING CLINIC OF GEORGIA, LLC

Table of content: (NPI 1669539508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669539508 NPI number — THE HEALTHCARING CLINIC OF GEORGIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTHCARING CLINIC OF GEORGIA, 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:
THE LITTLE CLINIC OF GEORGIA LLC
Provider Other Organization Name Type Code:
4
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:
1669539508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 681765
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-862-7276
Provider Business Mailing Address Fax Number:
502-423-1699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
491 EAST MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-535-1170
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOSCALZO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-907-2661

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1669539508 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: GRP7984 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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