1235264003 NPI number — MISS KRISTIN TIFFANY SZUROVY PA

Table of content: MISS KRISTIN TIFFANY SZUROVY PA (NPI 1235264003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235264003 NPI number — MISS KRISTIN TIFFANY SZUROVY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZUROVY
Provider First Name:
KRISTIN
Provider Middle Name:
TIFFANY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1235264003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 COLLIER ROAD NW
Provider Second Line Business Mailing Address:
SUITE 2035
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-605-2800
Provider Business Mailing Address Fax Number:
404-351-5983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 COLLIER ROAD NW
Provider Second Line Business Practice Location Address:
SUITE 2035
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-605-2800
Provider Business Practice Location Address Fax Number:
404-351-5983
Provider Enumeration Date:
02/22/2007

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: 363AM0700X , with the licence number:  4213 , 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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