1669663365 NPI number — CENTER OF HOPE FOR CANCERS AND BLOOD DISORDERS

Table of content: (NPI 1669663365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669663365 NPI number — CENTER OF HOPE FOR CANCERS AND BLOOD DISORDERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER OF HOPE FOR CANCERS AND BLOOD DISORDERS
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:
CENTER OF HOPE
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:
1669663365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-629-2337
Provider Business Mailing Address Fax Number:
770-629-5194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7444 HANNOVER PKWY
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-629-2337
Provider Business Practice Location Address Fax Number:
770-629-5194
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ONYEGBULA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
770-629-2337

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  053348 , 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: 696378996B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com