1346638285 NPI number — ROBIN RAIKEN BLEDSOE PMHCNS-BC

Table of content: ROBIN RAIKEN BLEDSOE PMHCNS-BC (NPI 1346638285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346638285 NPI number — ROBIN RAIKEN BLEDSOE PMHCNS-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLEDSOE
Provider First Name:
ROBIN
Provider Middle Name:
RAIKEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHCNS-BC
Provider Gender Code:
F

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:
1346638285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 BOULEVARD NE
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:
30312-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-658-1500
Provider Business Mailing Address Fax Number:
404-658-1535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
458 PONCE DE LEON AVE NE
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:
30308-1836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-815-1811
Provider Business Practice Location Address Fax Number:
404-815-1855
Provider Enumeration Date:
12/30/2014

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: 364SP0809X , with the licence number:  RN126178CNS , 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)





Copyright © 2007-2025 www.npivalidator.com