1689685893 NPI number — DR. TIMOTHY D GUEST DC

Table of content: DR. TIMOTHY D GUEST DC (NPI 1689685893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689685893 NPI number — DR. TIMOTHY D GUEST DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUEST
Provider First Name:
TIMOTHY
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1689685893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1269 BARCLAY CIR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-426-2935
Provider Business Mailing Address Fax Number:
770-426-2719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 SPRINGFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOILING SPRINGS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29316-7251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-578-8770
Provider Business Practice Location Address Fax Number:
864-599-4858
Provider Enumeration Date:
08/11/2006

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: 111N00000X , with the licence number:  008172 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1192 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH1192 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com