1063447464 NPI number — PAUL E CUNDEY III M.D.

Table of content: PAUL E CUNDEY III M.D. (NPI 1063447464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063447464 NPI number — PAUL E CUNDEY III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNDEY
Provider First Name:
PAUL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1063447464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1348 WALTON WAY
Provider Second Line Business Mailing Address:
SUITE 5100
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-724-8611
Provider Business Mailing Address Fax Number:
706-724-6202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1348 WALTON WAY
Provider Second Line Business Practice Location Address:
SUITE 5100
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901-5104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-724-8611
Provider Business Practice Location Address Fax Number:
706-724-6202
Provider Enumeration Date:
07/12/2006

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: 207RC0000X , with the licence number:  035399 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 17507 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2124563 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2211751-004 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: G35399 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 595431 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00661086B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4599825 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".




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