1003850926 NPI number — ASHBURN P SEARCY MD

Table of content: ASHBURN P SEARCY MD (NPI 1003850926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003850926 NPI number — ASHBURN P SEARCY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEARCY
Provider First Name:
ASHBURN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1003850926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1012 ACWORTH DUE WEST ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30152-4006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-424-6519
Provider Business Mailing Address Fax Number:
770-424-6520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MEMORIAL DRIVE WEST
Provider Second Line Business Practice Location Address:
WELLSTAR PAULDING HOSPITAL
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30132-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-443-7085
Provider Business Practice Location Address Fax Number:
770-505-7154
Provider Enumeration Date:
06/15/2006

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: 207L00000X , with the licence number:  011058 , 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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