1518010040 NPI number — EILEEN A DOVER CNM. APRN, MS

Table of content: EMMA SULLIVAN (NPI 1043943277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518010040 NPI number — EILEEN A DOVER CNM. APRN, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOVER
Provider First Name:
EILEEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM. APRN, MS
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:
1518010040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 COUNTY ROAD 1801
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLY POND
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35083-5336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-727-0822
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GEORGIA CENTER FOR FEMALE HEALTH
Provider Second Line Business Practice Location Address:
3660 FLAT SHOALS RD. SUITE 180
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30034-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-243-7777
Provider Business Practice Location Address Fax Number:
404-284-7676
Provider Enumeration Date:
01/19/2007

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: 176B00000X , with the licence number:  RN187527 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 1-059372 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 464145085A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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