1366547580 NPI number — NORTH FULTON UROLOGY PC

Table of content: (NPI 1366547580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366547580 NPI number — NORTH FULTON UROLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH FULTON UROLOGY PC
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:
1366547580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1357 HEMBREE RD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-5722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-475-7550
Provider Business Mailing Address Fax Number:
770-343-9080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1357 HEMBREE ROAD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-475-7550
Provider Business Practice Location Address Fax Number:
770-343-9080
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNI
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
770-475-7550

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CL8520 . This is a "RRMCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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