1164021101 NPI number — MRS. MARQUETTA WILLIAMS NOLBERT PHLEBOTOMY

Table of content: MRS. MARQUETTA WILLIAMS NOLBERT PHLEBOTOMY (NPI 1164021101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164021101 NPI number — MRS. MARQUETTA WILLIAMS NOLBERT PHLEBOTOMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS NOLBERT
Provider First Name:
MARQUETTA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHLEBOTOMY
Provider Gender Code:
F

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:
1164021101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1445 WOODMONT LN NW STE 3383
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-2866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-861-9991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
665 CASTLEBROOKE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30045-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-377-3353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2020

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: 246RP1900X , 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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