1881039550 NPI number — DR. LEE ANNE ADAMSON PH.D.

Table of content: DR. LEE ANNE ADAMSON PH.D. (NPI 1881039550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881039550 NPI number — DR. LEE ANNE ADAMSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMSON
Provider First Name:
LEE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1881039550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
704 VININGS ESTATES DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MABLETON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30126-5909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-694-4066
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5019 HIGHWAY 42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENWOOD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30294-3452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-694-4066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2013

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:  PSY 001807 , 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)