1104154806 NPI number — THE EMPOWERMENT ACADEMY FOR GIRLS AND WOMEN, INC.

Table of content: (NPI 1104154806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104154806 NPI number — THE EMPOWERMENT ACADEMY FOR GIRLS AND WOMEN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE EMPOWERMENT ACADEMY FOR GIRLS AND WOMEN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1104154806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7314 WAGON WHEEL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30236-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-665-7935
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7314 WAGON WHEEL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-665-7935
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VENISEE
Authorized Official First Name:
NIKKI
Authorized Official Middle Name:
MACHARIA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
404-665-7935

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  00000001 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 000003 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 000002 , 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: 101YA0400X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 163W00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171R00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 373H00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37470000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133N00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103K00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101YP2500X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104100000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 376K00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171M00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 374H00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172V00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101YM0800X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167G00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164W00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171W00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172A00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 174H00000X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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