1386773315 NPI number — GEORGIA REPRODUCTIVE SPEC 2 LLC

Table of content: MS. WINIFRED GAIL MCNAMARA ARNP (NPI 1457499196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386773315 NPI number — GEORGIA REPRODUCTIVE SPEC 2 LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA REPRODUCTIVE SPEC 2 LLC
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:
1386773315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 468329
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:
31146-8329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-943-0205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5445 MERIDIAN MARKS RD NE
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-4763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-943-0205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLDEN
Authorized Official First Name:
ALICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD
Authorized Official Telephone Number:
404-943-0205

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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