1790032712 NPI number — LIBERTY AND ASSOCIATES, INC.

Table of content: (NPI 1790032712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790032712 NPI number — LIBERTY AND ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY AND ASSOCIATES, 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:
FAVORED HEALTHCARE SERVICES
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:
1790032712
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 FOSTER TRACE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30043-6545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-401-0266
Provider Business Mailing Address Fax Number:
770-338-7716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 FOSTER TRACE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30043-6545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-401-0266
Provider Business Practice Location Address Fax Number:
770-338-7716
Provider Enumeration Date:
08/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OKWARAOHA
Authorized Official First Name:
CHIBUEZE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CEO
Authorized Official Telephone Number:
404-401-0266

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  RN208307 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 067-R-0958 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: RN208307 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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