1023395811 NPI number — DR. BARBARA FAYE BUIE PH.D, GC-C, IDD

Table of content: DR. BARBARA FAYE BUIE PH.D, GC-C, IDD (NPI 1023395811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023395811 NPI number — DR. BARBARA FAYE BUIE PH.D, GC-C, IDD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUIE
Provider First Name:
BARBARA
Provider Middle Name:
FAYE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D, GC-C, IDD
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:
1023395811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2919 LEE DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOGUE CHITTO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39629-9414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-754-1674
Provider Business Mailing Address Fax Number:
601-734-6737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2919 LEE DR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOGUE CHITTO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39629-9414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-754-1674
Provider Business Practice Location Address Fax Number:
601-734-6737
Provider Enumeration Date:
11/08/2011

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: 101YM0800X , with the licence number:  136982 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com