1013305309 NPI number — RASHEEDA SADIQUA ABDUR-RAHMAN MSW

Table of content: RASHEEDA SADIQUA ABDUR-RAHMAN MSW (NPI 1013305309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013305309 NPI number — RASHEEDA SADIQUA ABDUR-RAHMAN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDUR-RAHMAN
Provider First Name:
RASHEEDA
Provider Middle Name:
SADIQUA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAA
Provider Other First Name:
RASHEEDA
Provider Other Middle Name:
SADIQUA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1013305309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1492 RIVERROCK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30296-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-910-2952
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8484 HIGHWAY 85
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30238-4308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-788-7400
Provider Business Practice Location Address Fax Number:
678-954-6896
Provider Enumeration Date:
01/08/2015

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: 104100000X , with the licence number:  CSW005258 , 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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