1134226418 NPI number — NHC ROSSVILLE MCFARLAND AVE ROSSVILLE G A.

Table of content: ANTHONY MICHAEL DUPREE JR. (NPI 1952177875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134226418 NPI number — NHC ROSSVILLE MCFARLAND AVE ROSSVILLE G A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NHC ROSSVILLE MCFARLAND AVE ROSSVILLE G A.
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:
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:
1134226418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3827 LARRY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37411-1610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-622-0008
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 MCFARLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30741-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-861-0863
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
REGINALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
FRC
Authorized Official Telephone Number:
706-861-0863

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  PTA 673 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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