1093886608 NPI number — WILLIAM ANDREW THORNTON APRN-BC, FNP

Table of content: WILLIAM ANDREW THORNTON APRN-BC, FNP (NPI 1093886608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093886608 NPI number — WILLIAM ANDREW THORNTON APRN-BC, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
WILLIAM
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC, FNP
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:
1093886608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 WEHUNT PL SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30082-4845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-761-4106
Provider Business Mailing Address Fax Number:
770-432-1648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3720 DAVINCI CT
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30092-7627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-628-0371
Provider Business Practice Location Address Fax Number:
770-582-4189
Provider Enumeration Date:
11/13/2006

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: 363LF0000X , with the licence number:  RN166395-NP , 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)

  • Identifier: 269139867B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com