1255799649 NPI number — MRS. GEORGIA GLENN HAZZARD CNP

Table of content: MRS. GEORGIA GLENN HAZZARD CNP (NPI 1255799649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255799649 NPI number — MRS. GEORGIA GLENN HAZZARD CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZZARD
Provider First Name:
GEORGIA
Provider Middle Name:
GLENN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1255799649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 300
Provider Second Line Business Mailing Address:
11271 STATE ROUTE 762
Provider Business Mailing Address City Name:
ORIENT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43146-0300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 11271 STATE ROUTE 762
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORIENT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-877-2441
Provider Business Practice Location Address Fax Number:
614-877-3853
Provider Enumeration Date:
02/01/2016

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: 363LA2200X , with the licence number:  17306 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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