1497140735 NPI number — CRYSTAL CLEAR CONSULTATIONS, INC.

Table of content: (NPI 1497140735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497140735 NPI number — CRYSTAL CLEAR CONSULTATIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRYSTAL CLEAR CONSULTATIONS, 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:
6
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:
1497140735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 HIGHLAND AVE NE STE 329
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:
30312-1301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-720-0877
Provider Business Mailing Address Fax Number:
404-720-0877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 ATLANTA AVE SE
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:
30315-1804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-906-8471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
SULONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
404-720-0877

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC006644 , 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