1770580300 NPI number — WILLIAM D. TUMLIN

Table of content: (NPI 1770580300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770580300 NPI number — WILLIAM D. TUMLIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM D. TUMLIN
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:
CRAWFORD LEXINGTON MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1770580300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 69
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30648-0069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-743-8183
Provider Business Mailing Address Fax Number:
706-743-3233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
774 ATHENS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30648-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-743-8183
Provider Business Practice Location Address Fax Number:
706-743-3233
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEARD
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
706-743-8183

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  N/A , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 021100 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 083452 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00753497B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00147419A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00665794A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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