1497361414 NPI number — QADRIYYAH TAHEERAH ALALIM NP

Table of content: QADRIYYAH TAHEERAH ALALIM NP (NPI 1497361414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497361414 NPI number — QADRIYYAH TAHEERAH ALALIM NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALALIM
Provider First Name:
QADRIYYAH
Provider Middle Name:
TAHEERAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AL-ALIM
Provider Other First Name:
QADRIYYAH
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1497361414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 156
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARROTT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39877-0156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-879-9249
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31705-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-500-2329
Provider Business Practice Location Address Fax Number:
229-500-4891
Provider Enumeration Date:
09/16/2020

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: 207Q00000X , with the licence number:  RN163976 , 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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