1770031544 NPI number — CHATTAHOOCHEE FAMILY ORTHODONTICS

Table of content: DR. CALVIN MARK NEWTON M.D. (NPI 1205857653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770031544 NPI number — CHATTAHOOCHEE FAMILY ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHATTAHOOCHEE FAMILY ORTHODONTICS
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:
1770031544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
342 N MAIN ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30009-8376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-888-7798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 PEACHTREE INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
STE 1102
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-8819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-888-7798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
770-231-5348

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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