1285655704 NPI number — RITA GRAYSON LCSW

Table of content: MR. MOSES DAVID ALVAREZ DIPL. AC., LAC., RN (NPI 1508924648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285655704 NPI number — RITA GRAYSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAYSON
Provider First Name:
RITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1285655704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 WINTERGATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30022-5584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-417-1004
Provider Business Mailing Address Fax Number:
770-840-0162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 RESEARCH CT
Provider Second Line Business Practice Location Address:
SUITE 725
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-6609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-557-4144
Provider Business Practice Location Address Fax Number:
770-840-0162
Provider Enumeration Date:
07/21/2006

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: 1041C0700X , with the licence number:  CSW029575 , 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: 00968734A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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