1538230420 NPI number — MRS. KATHERINE ATKINSON MANN

Table of content: MRS. KATHERINE ATKINSON MANN (NPI 1538230420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538230420 NPI number — MRS. KATHERINE ATKINSON MANN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANN
Provider First Name:
KATHERINE
Provider Middle Name:
ATKINSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1538230420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 69
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE RIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30513-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-258-4040
Provider Business Mailing Address Fax Number:
706-258-4041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 OVERVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE RIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30513-6611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-258-4040
Provider Business Practice Location Address Fax Number:
706-258-4041
Provider Enumeration Date:
11/13/2006

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: 367500000X , with the licence number:  RN040017 , 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: 00481863B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10039402 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 430028175 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4600549 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8050156 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 342304 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52054224-001 . This is a "BLUE CROSS GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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