1174681324 NPI number — GTL, INCORPORATED

Table of content: CHARLEE ISON (NPI 1851027924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174681324 NPI number — GTL, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GTL, INCORPORATED
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:
1174681324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27475 MEADOWBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48377-3532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-557-4462
Provider Business Mailing Address Fax Number:
800-325-5145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27475 MEADOWBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48377-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-557-4462
Provider Business Practice Location Address Fax Number:
800-325-5145
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HELLIER
Authorized Official First Name:
JOSCELYN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
COMPLIANCE ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
612-237-2571

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333300000X , with the licence number: 3601205334 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1174681324 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174681324 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A0004060 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000439524A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110029468B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000802051A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001633617 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 037965419 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174681324 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3121712 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000439524B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1174681324 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30003874820001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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