1437432358 NPI number — GA HIGHLANDS OB/GYN, PC

Table of content: (NPI 1437432358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437432358 NPI number — GA HIGHLANDS OB/GYN, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GA HIGHLANDS OB/GYN, 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:
1437432358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
962 JOE FRANK HARRIS PKWY,
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
CARTERSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30120-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-334-8818
Provider Business Mailing Address Fax Number:
770-334-8819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
962 JOE FRANK HARRIS PKWY,
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-334-8818
Provider Business Practice Location Address Fax Number:
770-334-8819
Provider Enumeration Date:
09/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KADUM
Authorized Official First Name:
FAREED
Authorized Official Middle Name:
Z
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
770-334-8818

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  GA022993 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1760495840 . This is a "NPI FAREED Z. KADUM, MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000262556D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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