1376639237 NPI number — DR. MARY CAROLYN DOWNING M.D.

Table of content: DR. LARISA POTAP M.D (NPI 1528117108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376639237 NPI number — DR. MARY CAROLYN DOWNING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWNING
Provider First Name:
MARY
Provider Middle Name:
CAROLYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1376639237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 LEXINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31404-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-350-7171
Provider Business Mailing Address Fax Number:
912-350-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31404-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-350-7171
Provider Business Practice Location Address Fax Number:
912-350-3454
Provider Enumeration Date:
10/05/2006

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: 207RC0000X , with the licence number:  MD.204487 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 058410 , 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)

  • Identifier: 2149148 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 452476642G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01048150 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 452476642D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 452476642H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07227344 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: G58410 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 452476642J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 452476642F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 452476642E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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