1740463462 NPI number — COMFORTING SOLES INC.

Table of content: (NPI 1740463462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740463462 NPI number — COMFORTING SOLES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORTING SOLES INC.
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:
1740463462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1813 CEDAR GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONLEY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30288-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-468-6744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4153 FLAT SHOALS PKWY STE 316C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30034-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-468-6744
Provider Business Practice Location Address Fax Number:
800-976-5001
Provider Enumeration Date:
12/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIVINS
Authorized Official First Name:
REGINALD
Authorized Official Middle Name:
BERNARD
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
404-468-6744

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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