1326039231 NPI number — LUIS GALVEZ MD

Table of content: LUIS GALVEZ MD (NPI 1326039231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326039231 NPI number — LUIS GALVEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALVEZ
Provider First Name:
LUIS
Provider Middle Name:
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:
1326039231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 PEACHTREE ST NE
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30308-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-885-7701
Provider Business Mailing Address Fax Number:
404-885-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5671 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-257-9000
Provider Business Practice Location Address Fax Number:
404-847-9792
Provider Enumeration Date:
10/31/2005

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: 207RG0100X , with the licence number:  36746 , 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: 000539877D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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