1225564677 NPI number — ONE HEALTH RESEARCH CLINIC, INC

Table of content: (NPI 1225564677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225564677 NPI number — ONE HEALTH RESEARCH CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE HEALTH RESEARCH CLINIC, INC
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:
1225564677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5430 JIMMY CARTER BLVD
Provider Second Line Business Mailing Address:
SUITE 200B
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30093-1517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-585-4917
Provider Business Mailing Address Fax Number:
678-691-8129

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5430 JIMMY CARTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 200B
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30093-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-585-4917
Provider Business Practice Location Address Fax Number:
678-691-8129
Provider Enumeration Date:
05/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FISCHER
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SITE DIRECTOR
Authorized Official Telephone Number:
678-585-4917

Provider Taxonomy Codes

  • Taxonomy code: 170100000X , with the licence number:  9270 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 170100000X , with the licence number: 30147 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 170100000X , with the licence number: 35421 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1235345588 . This is a "1235345588" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1225028947 . This is a "1225028947" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1669555819 . This is a "1669555819" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1710088505 . This is a "1710088505" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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