1770952707 NPI number — CORDINAT MEDICAL STAFFING AND CONSULTING

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 1770952707 NPI number — CORDINAT MEDICAL STAFFING AND CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORDINAT MEDICAL STAFFING AND CONSULTING
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:
CORDINAT MEDICAL CONSULTING
Provider Other Organization Name Type Code:
5
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:
1770952707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1475 BUFORD DR
Provider Second Line Business Mailing Address:
SUTIE 403-154
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30043-3798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-242-5823
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 BUFORD DR
Provider Second Line Business Practice Location Address:
SUTIE 403-154
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30043-3798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-242-5823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BOWEN
Authorized Official First Name:
DETRESE
Authorized Official Middle Name:
REJANET
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
470-242-5823

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  2015015535 , 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)





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