1508896390 NPI number — DR. SUSAN ACKER STALLINGS-SAHLER PH.D.

Table of content: DR. SUSAN ACKER STALLINGS-SAHLER PH.D. (NPI 1508896390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508896390 NPI number — DR. SUSAN ACKER STALLINGS-SAHLER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STALLINGS-SAHLER
Provider First Name:
SUSAN
Provider Middle Name:
ACKER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1508896390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3624 OLD PETERSBURG RD
Provider Second Line Business Mailing Address:
PETERSBURG PLAZA
Provider Business Mailing Address City Name:
MARTINEZ
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30907-2865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-413-3136
Provider Business Mailing Address Fax Number:
706-364-3470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3624 OLD PETERSBURG RD
Provider Second Line Business Practice Location Address:
PETERSBURG PLAZA
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30907-2865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-413-3136
Provider Business Practice Location Address Fax Number:
706-364-3470
Provider Enumeration Date:
07/04/2006

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: 225XP0200X , with the licence number:  OT003825 , 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: OT003825 . This is a "OT LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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