1699875393 NPI number — STEPHANIE MCNAMARA HINES ATC, OTC

Table of content: STEPHANIE MCNAMARA HINES ATC, OTC (NPI 1699875393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699875393 NPI number — STEPHANIE MCNAMARA HINES ATC, OTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
STEPHANIE
Provider Middle Name:
MCNAMARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC, OTC
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:
1699875393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3552 CHATTAHOOCHEE SUMMIT LN SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-3290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-558-4485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 PEACHTREE RD NE
Provider Second Line Business Practice Location Address:
SUITE 705
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-425-1165
Provider Business Practice Location Address Fax Number:
404-425-1063
Provider Enumeration Date:
09/22/2006

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: 246ZS0410X , with the licence number:  07-0802 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2255A2300X , with the licence number: AT001430 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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