1053505560 NPI number — MR. SAMUEL NIGHTINGALE SURGICAL FIRST ASST.

Table of content: MR. SAMUEL NIGHTINGALE SURGICAL FIRST ASST. (NPI 1053505560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053505560 NPI number — MR. SAMUEL NIGHTINGALE SURGICAL FIRST ASST.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIGHTINGALE
Provider First Name:
SAMUEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SURGICAL FIRST ASST.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIGHTINGALE
Provider Other First Name:
SAMUEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED SURGICAL A
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053505560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 PEACHTREE RD NE
Provider Second Line Business Mailing Address:
SUITE D-312
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-468-7781
Provider Business Mailing Address Fax Number:
770-785-9882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2221 PEACHTREE RD NE
Provider Second Line Business Practice Location Address:
SUITE D-312
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-468-7781
Provider Business Practice Location Address Fax Number:
770-785-9882
Provider Enumeration Date:
08/29/2007

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: 246Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com