1871571380 NPI number — DR. MARILYN THERESE SCHORN-BELLOWS AU.D., CCC/A

Table of content: DR. MARILYN THERESE SCHORN-BELLOWS AU.D., CCC/A (NPI 1871571380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871571380 NPI number — DR. MARILYN THERESE SCHORN-BELLOWS AU.D., CCC/A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHORN-BELLOWS
Provider First Name:
MARILYN
Provider Middle Name:
THERESE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC/A
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:
1871571380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3629 ELEANORS TRCE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30506-3648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-534-8660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 JOHN W MORROW JR PKWY
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501-8531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-532-5092
Provider Business Practice Location Address Fax Number:
770-531-1865
Provider Enumeration Date:
01/04/2006

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: 231H00000X , with the licence number:  1240 , 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)





Copyright © 2007-2025 www.npivalidator.com