1477842177 NPI number — ERICA LYNN SESSLER PANCOAST PA-C

Table of content: MS. VIRGINIA LEE NORFOLK LLPC (NPI 1164582235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477842177 NPI number — ERICA LYNN SESSLER PANCOAST PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SESSLER PANCOAST
Provider First Name:
ERICA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SESSLER
Provider Other First Name:
ERICA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477842177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 TOWER ROAD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-9403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-427-5717
Provider Business Mailing Address Fax Number:
770-514-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 TOWER ROAD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-9403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-427-5717
Provider Business Practice Location Address Fax Number:
770-514-5040
Provider Enumeration Date:
04/04/2011

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: 363AS0400X , with the licence number:  006080 , 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: 20297I9551 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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