1093155897 NPI number — DR. CHRISTEN PIRKLE SUBBIAH MD

Table of content: DR. CHRISTEN PIRKLE SUBBIAH MD (NPI 1093155897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093155897 NPI number — DR. CHRISTEN PIRKLE SUBBIAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBBIAH
Provider First Name:
CHRISTEN
Provider Middle Name:
PIRKLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIRKLE
Provider Other First Name:
CHRISTEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093155897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4374 OGLETHORPE LOOP NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ACWORTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30101-9533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-642-8771
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 COURTYARD DR SE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120-8535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-640-0206
Provider Business Practice Location Address Fax Number:
770-386-7910
Provider Enumeration Date:
06/26/2013

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: 207R00000X , with the licence number:  076139 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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