1245336981 NPI number — MRS. CARLA BADER-HENDERSON OTR, CHT

Table of content: MRS. CARLA BADER-HENDERSON OTR, CHT (NPI 1245336981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245336981 NPI number — MRS. CARLA BADER-HENDERSON OTR, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADER-HENDERSON
Provider First Name:
CARLA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR, CHT
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:
1245336981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 CIRCLE 75 PKWY SE
Provider Second Line Business Mailing Address:
SUITE 1700
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-953-6929
Provider Business Mailing Address Fax Number:
770-953-6972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1240 EAGLES LANDING PKWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-5170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-506-4350
Provider Business Practice Location Address Fax Number:
770-506-9860
Provider Enumeration Date:
09/16/2006

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: 225X00000X , with the licence number:  OT000673 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , with the licence number: OT000673 , 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)





Copyright © 2007-2025 www.npivalidator.com