1265703557 NPI number — MR. EDWARD MONROE COURTNEY JR. MPT

Table of content: MR. EDWARD MONROE COURTNEY JR. MPT (NPI 1265703557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265703557 NPI number — MR. EDWARD MONROE COURTNEY JR. MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COURTNEY
Provider First Name:
EDWARD
Provider Middle Name:
MONROE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MPT
Provider Gender Code:
M

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:
1265703557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 EAST HOSPITAL ROAD
Provider Second Line Business Mailing Address:
D.D. EISENHOWER ARMY MEDICAL CENTER ROOM 12C-25
Provider Business Mailing Address City Name:
AUGUSTA FORT GORDON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30905-5650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-787-8441
Provider Business Mailing Address Fax Number:
706-787-1327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 EAST HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
D.D. EISENHOWER ARMY MEDICAL CENTER ROOM 12C-25
Provider Business Practice Location Address City Name:
AUGUSTA FORT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-8441
Provider Business Practice Location Address Fax Number:
706-787-1327
Provider Enumeration Date:
01/19/2012

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: 246Z00000X , with the licence number:  PT007866 , 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