1740322858 NPI number — NEXTCARE GEORGIA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740322858 NPI number — NEXTCARE GEORGIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXTCARE 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:
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:
1740322858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 N THUNDERBIRD CIRCLE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85215-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-924-8382
Provider Business Mailing Address Fax Number:
480-776-1605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 CAROLINE ST NE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30307-2749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-849-5609
Provider Business Practice Location Address Fax Number:
910-868-3216
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARPLE
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VP REIMBURSEMENT SERVICES
Authorized Official Telephone Number:
480-924-8382

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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