1033249347 NPI number — MS. MARILYN BETHUNE BARNETT LPTA

Table of content: MS. MARILYN BETHUNE BARNETT LPTA (NPI 1033249347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033249347 NPI number — MS. MARILYN BETHUNE BARNETT LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNETT
Provider First Name:
MARILYN
Provider Middle Name:
BETHUNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
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:
1033249347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 UNIVERSITY BLVD, EAST
Provider Second Line Business Mailing Address:
SUITE #14
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-445-3191
Provider Business Mailing Address Fax Number:
301-445-3198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2185 NORTHLAKE PARKWAY
Provider Second Line Business Practice Location Address:
BUILDING 8, SUITE 100
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-493-6360
Provider Business Practice Location Address Fax Number:
301-445-3198
Provider Enumeration Date:
03/06/2007

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: 225200000X , with the licence number:  A2363 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X , with the licence number: 2306603805 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: PTA003179 , 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)





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