1003697103 NPI number — MRS. COURTNAY KELLY PERRYMAN PMHNP-BC

Table of content: MRS. COURTNAY KELLY PERRYMAN PMHNP-BC (NPI 1003697103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003697103 NPI number — MRS. COURTNAY KELLY PERRYMAN PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRYMAN
Provider First Name:
COURTNAY
Provider Middle Name:
KELLY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
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:
1003697103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11731 SALEM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAVO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31778-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-403-4868
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 SMITH AVE STE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31792-5740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-225-4335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2023

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: 363LP0808X , with the licence number:  RN236174 , 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