1801189402 NPI number — VALDOSTA STATE UNIVERSITY STUDENT HEALTH SERVICES

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 1801189402 NPI number — VALDOSTA STATE UNIVERSITY STUDENT HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALDOSTA STATE UNIVERSITY STUDENT HEALTH SERVICES
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:
1801189402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GEORGIA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-333-5886
Provider Business Mailing Address Fax Number:
229-249-2791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GEORGIA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-333-5886
Provider Business Practice Location Address Fax Number:
229-249-2791
Provider Enumeration Date:
05/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HIATT
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
229-333-5886

Provider Taxonomy Codes

  • Taxonomy code: 163WC1400X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , 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: 1093816662 . This is a "SHONTA WINBUSH MD TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1730180191 . This is a "WILLIAM GROW MD TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1336465301 . This is a "KRISTEN DUNCAN WHNP BC TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023158763 . This is a "BARBARA PEARCE RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1447492582 . This is a "IVY FRALICK RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720156417 . This is a "ELSIE NAPIER RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1841504156 . This is a "DORAINE WEBB RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1891095840 . This is a "KAREN BOWSER RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003946781 . This is a "DEBBIE REAGAN MSN ARNP BC TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1679772419 . This is a "STACY REID RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1730308883 . This is a "KIMBERLY S SNOW RN FNP TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1841341500 . This is a "TERESA JOHNSON RN TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699889121 . This is a "EDWIN L HIATT MD TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1831194760 . This is a "LEON MEEKS MD TYPE I NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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