1326734252 NPI number — MRS. THEODORA LONGARDT BAIR M.ED., M.S., NCC

Table of content: MRS. THEODORA LONGARDT BAIR M.ED., M.S., NCC (NPI 1326734252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326734252 NPI number — MRS. THEODORA LONGARDT BAIR M.ED., M.S., NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAIR
Provider First Name:
THEODORA
Provider Middle Name:
LONGARDT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., M.S., NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAIR
Provider Other First Name:
TEDDI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., M.S., NCC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326734252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2744 PEACHTREE RD NW
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:
30305-2937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-333-8760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2744 PEACHTREE RD NW
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:
30305-2937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-333-8760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2023

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: 101YM0800X , with the licence number:  APC008713 , 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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