1073931820 NPI number — MR. HARRIS TODD POPE NCAC II, CCS

Table of content: MR. HARRIS TODD POPE NCAC II, CCS (NPI 1073931820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073931820 NPI number — MR. HARRIS TODD POPE NCAC II, CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POPE
Provider First Name:
HARRIS
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
NCAC II, CCS
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:
1073931820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1143
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMEN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30110-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-447-4289
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 PRISM DR.
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30116-9349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-447-4289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2014

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: 101YA0400X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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