1932007382 NPI number — OCTAVIUS DEANTHONY ARMSTRONG ASST LASER PRAC.

Table of content: OCTAVIUS DEANTHONY ARMSTRONG ASST LASER PRAC. (NPI 1932007382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932007382 NPI number — OCTAVIUS DEANTHONY ARMSTRONG ASST LASER PRAC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
OCTAVIUS
Provider Middle Name:
DEANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASST LASER PRAC.
Provider Gender Code:
M

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:
1932007382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
660 11TH ST NW STE 2B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-6790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
770-296-4128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
660 11TH ST NW STE 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30318-6790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-296-4128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2026

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: 374700000X , with the licence number:  2194 , 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)





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