1134232937 NPI number — MRS. DEBORAH MCNAIR MCTURK OTRL

Table of content: MRS. DEBORAH MCNAIR MCTURK OTRL (NPI 1134232937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134232937 NPI number — MRS. DEBORAH MCNAIR MCTURK OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCTURK
Provider First Name:
DEBORAH
Provider Middle Name:
MCNAIR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LYON
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
MCNAIR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1134232937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1062 RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-245-9428
Provider Business Mailing Address Fax Number:
229-253-8904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1062 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALDOSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-245-9428
Provider Business Practice Location Address Fax Number:
229-253-8904
Provider Enumeration Date:
08/16/2006

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: 225X00000X , with the licence number:  OT002364 , 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)





Copyright © 2007-2024 www.npivalidator.com