1447784244 NPI number — MR. JON WESLEY NEWCOMER II B.S.

Table of content: MR. JON WESLEY NEWCOMER II B.S. (NPI 1447784244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447784244 NPI number — MR. JON WESLEY NEWCOMER II B.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWCOMER
Provider First Name:
JON
Provider Middle Name:
WESLEY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
B.S.
Provider Gender Code:
M

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:
1447784244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3284 NORTHSIDE PKWY NW
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30327-2280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-782-1184
Provider Business Mailing Address Fax Number:
877-241-5672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3284 NORTHSIDE PKWY NW
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30327-2280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-782-1184
Provider Business Practice Location Address Fax Number:
877-241-5672
Provider Enumeration Date:
04/18/2017

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: 246ZE0600X , with the licence number:  052516617 , 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)





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