1831184027 NPI number — MRS. KARLINE WILSON MITCHELL CNM

Table of content: MRS. KARLINE WILSON MITCHELL CNM (NPI 1831184027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831184027 NPI number — MRS. KARLINE WILSON MITCHELL CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
KARLINE
Provider Middle Name:
WILSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
KARLINE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831184027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 TAWN CRESCENT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AJAX
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L1Z1H9
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
416-909-1791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2675 N DECATUR RD
Provider Second Line Business Practice Location Address:
STE 512
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-508-2000
Provider Business Practice Location Address Fax Number:
404-508-5560
Provider Enumeration Date:
09/14/2005

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: 367A00000X , with the licence number:  RN168891 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: ARNP1967452 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 611377940AB , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP632 . This is a "GROUP MEDICARE" identifier . This identifiers is of the category "OTHER".




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