1801189402 NPI number — VALDOSTA STATE UNIVERSITY STUDENT HEALTH SERVICES

Table of content: (NPI 1801189402)

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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