1386080026 NPI number — P.R.I..S.S.Y GIRLS P.E.R.F.E.C.T GENTLEMAN INC

Table of content: (NPI 1386080026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386080026 NPI number — P.R.I..S.S.Y GIRLS P.E.R.F.E.C.T GENTLEMAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P.R.I..S.S.Y GIRLS P.E.R.F.E.C.T GENTLEMAN INC
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:
1386080026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9203 PEACHTREE CREEK CIR
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:
30341-5378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-524-2011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9203 PEACHTREE CREEK
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:
30341-5378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-524-2011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
JORONICA
Authorized Official Title or Position:
FOUNDER, EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
678-524-2011

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  251B00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 251B00000X , 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