1295722205 NPI number — MRS. APOLLONE SIMONE REID P.T., MPH

Table of content: MRS. APOLLONE SIMONE REID P.T., MPH (NPI 1295722205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295722205 NPI number — MRS. APOLLONE SIMONE REID P.T., MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID
Provider First Name:
APOLLONE
Provider Middle Name:
SIMONE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T., MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REID
Provider Other First Name:
APOLLONE
Provider Other Middle Name:
SIMONE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T., MPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295722205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 SMALL ELK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBURN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30213-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-518-8206
Provider Business Mailing Address Fax Number:
404-292-4452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 SMALL ELK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30213-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-518-8206
Provider Business Practice Location Address Fax Number:
404-292-4452
Provider Enumeration Date:
10/04/2005

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: 225100000X , with the licence number:  PT001355 , 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)





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