1861554776 NPI number — MS. REGINA DELICIA WARD EDD

Table of content: MS. REGINA DELICIA WARD EDD (NPI 1861554776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861554776 NPI number — MS. REGINA DELICIA WARD EDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
REGINA
Provider Middle Name:
DELICIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
EDD
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:
1861554776
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4222 CHESTNUT LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHONIA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30038-4568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-456-6291
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3553B MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30032-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-289-6299
Provider Business Practice Location Address Fax Number:
404-289-6298
Provider Enumeration Date:
12/15/2006

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: 103T00000X , with the licence number:  LPC003980 , 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: 834417259A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com