1992861900 NPI number — DR. RUTH M CLINE M.D.

Table of content: DR. RUTH M CLINE M.D. (NPI 1992861900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992861900 NPI number — DR. RUTH M CLINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLINE
Provider First Name:
RUTH
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.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:
1992861900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5780 PEACHTREE DUNWOODY ROAD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-303-1224
Provider Business Mailing Address Fax Number:
404-303-1325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 PRINCE AVE
Provider Second Line Business Practice Location Address:
BLDG 3
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-548-4272
Provider Business Practice Location Address Fax Number:
706-548-9181
Provider Enumeration Date:
12/28/2006

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: 174400000X , with the licence number:  036570 , 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: 000660921C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 498446 . This is a "BCBS NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com