1285621110 NPI number — STANFORD R. PLAVIN MD

Table of content: STANFORD R. PLAVIN MD (NPI 1285621110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285621110 NPI number — STANFORD R. PLAVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLAVIN
Provider First Name:
STANFORD
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1285621110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
438 TARA TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30327-4926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-242-6360
Provider Business Mailing Address Fax Number:
404-549-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 GLENRIDGE DRIVE, BUILDING 3
Provider Second Line Business Practice Location Address:
SUITE 101-123
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-242-6360
Provider Business Practice Location Address Fax Number:
404-549-2853
Provider Enumeration Date:
10/05/2005

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: 207L00000X , with the licence number:  17526 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: G136300 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 39201 , 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)

  • Identifier: 000635599C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000635599H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 025058600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com