1376269910 NPI number — MRS. CARRIE PLAYER SEXTON PHIL, MS,CTP, BS,CSC

Table of content: MRS. CARRIE PLAYER SEXTON PHIL, MS,CTP, BS,CSC (NPI 1376269910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376269910 NPI number — MRS. CARRIE PLAYER SEXTON PHIL, MS,CTP, BS,CSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEXTON
Provider First Name:
CARRIE
Provider Middle Name:
PLAYER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHIL, MS,CTP, BS,CSC
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:
1376269910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MISTY FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHENIX CITY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36869-3492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-460-2361
Provider Business Mailing Address Fax Number:
706-287-1124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 GENTIAN BLVD STE 8A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31907-5639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-530-8756
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2022

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1376269910 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093978439 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1376269944 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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