1336435726 NPI number — NORTH METRO ORAL & MAXILLOFACIAL SURGERY, LLC

Table of content: DR. HEIDI ADLMAN BROWNE MD (NPI 1295197358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336435726 NPI number — NORTH METRO ORAL & MAXILLOFACIAL SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH METRO ORAL & MAXILLOFACIAL SURGERY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336435726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4508 HOLLY SPGS PKWY
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30115-7842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-345-8118
Provider Business Mailing Address Fax Number:
770-345-7219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4508 HOLLY SPGS PKWY
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30115-7842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-345-8118
Provider Business Practice Location Address Fax Number:
770-345-7219
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CAREY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT/ORAL SURGEON
Authorized Official Telephone Number:
770-345-8118

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  012148 , 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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