1134316508 NPI number — MRS. SERITHA CAROL GILBERT RPH

Table of content: MRS. SERITHA CAROL GILBERT RPH (NPI 1134316508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134316508 NPI number — MRS. SERITHA CAROL GILBERT RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILBERT
Provider First Name:
SERITHA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COUNTS
Provider Other First Name:
SERITHA
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134316508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 MOUNT ZION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONAIRE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31005-4426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-287-6112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 7TH ST BLDG 700700-A
Provider Second Line Business Practice Location Address:
78 MDG/SGHC-CREDENTIALS
Provider Business Practice Location Address City Name:
ROBINS AFB
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31098-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-287-6112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2007

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: 183500000X , with the licence number:  007731 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: RPH021435 , 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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