1295723492 NPI number — DR. MICHEL BRATHWAITE MD

Table of content: DR. MICHEL BRATHWAITE MD (NPI 1295723492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295723492 NPI number — DR. MICHEL BRATHWAITE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRATHWAITE
Provider First Name:
MICHEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1295723492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3620 MARTIN LUTHER KING JR DR SW
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:
30331-3711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-696-7300
Provider Business Mailing Address Fax Number:
404-699-3514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3620 MARTIN LUTHER KING JR DR SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30331-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-696-7300
Provider Business Practice Location Address Fax Number:
404-699-3514
Provider Enumeration Date:
10/11/2005

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: 207RN0300X , with the licence number:  038694 , 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: 000618076M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000618076N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 505411 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 726082 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000618076H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000618076F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000618076K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110091303 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 3120000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000618076A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000618076C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 506853 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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