1245540566 NPI number — MISS EMMALYN V. TAGUE PHYSICIAN ASSOCIATE

Table of content: MISS EMMALYN V. TAGUE PHYSICIAN ASSOCIATE (NPI 1245540566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245540566 NPI number — MISS EMMALYN V. TAGUE PHYSICIAN ASSOCIATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAGUE
Provider First Name:
EMMALYN
Provider Middle Name:
V.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSOCIATE
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:
1245540566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
78TH MEDICAL GROUP
Provider Second Line Business Mailing Address:
655 SEVENTH ST
Provider Business Mailing Address City Name:
ROBINS AFB
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-327-8487
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
78TH MEDICAL GROUP
Provider Second Line Business Practice Location Address:
655 SEVENTH ST
Provider Business Practice Location Address City Name:
ROBINS AFB
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-327-8487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2010

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: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; 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