1003060609 NPI number — WS AND SKY INC

Table of content: (NPI 1003060609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003060609 NPI number — WS AND SKY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WS AND SKY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1003060609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2790 LAWRENCEVILLE SUWANEE RD
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-2671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-932-3023
Provider Business Mailing Address Fax Number:
770-932-2314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2790 LAWRENCEVILLE SUWANEE RD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-2671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-932-3023
Provider Business Practice Location Address Fax Number:
770-932-2314
Provider Enumeration Date:
11/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YIM
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
MGMNT, PIC
Authorized Official Telephone Number:
770-932-3023

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE009522 , 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: 329434653A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2117750 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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