1023249760 NPI number — JEFFREY D. ESSLINGER, MD, PC

Table of content: (NPI 1023249760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023249760 NPI number — JEFFREY D. ESSLINGER, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY D. ESSLINGER, MD, PC
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:
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:
1023249760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COURTYARD DR SE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CARTERSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30120-8535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-386-5330
Provider Business Mailing Address Fax Number:
770-382-7536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COURTYARD DR SE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120-8535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-386-5330
Provider Business Practice Location Address Fax Number:
770-382-7536
Provider Enumeration Date:
07/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESSLINGER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
770-386-5330

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  45455 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , with the licence number: 000696 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)