1801858527 NPI number — TRACY KATHLEEN JONES FNP.C

Table of content: MARIA MULLET (NPI 1528794773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801858527 NPI number — TRACY KATHLEEN JONES FNP.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
TRACY
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP.C
Provider Gender Code:
F

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:
1801858527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 HOSPITAL SOUTH DR
Provider Second Line Business Mailing Address:
SUITE 502 GASTROINTESTINAL SPECIALISTS OF GA, PC
Provider Business Mailing Address City Name:
AUSTCEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-741-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6043 PRESTLEY MILL RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-739-9555
Provider Business Practice Location Address Fax Number:
678-741-2301
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN112762 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: RN112762 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 0340729 22 , 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)

  • Identifier: 300035305B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50BBDWC . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 651375375A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CEP12680 . This is a "RN PROVIDER ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000902327A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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