1538320320 NPI number — JANE T. ST CLAIR, MD, PC

Table of content: DR. BENJAMIN HENRY HURD DMD (NPI 1215317078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538320320 NPI number — JANE T. ST CLAIR, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANE T. ST CLAIR, MD, PC
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:
1538320320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
851 SPRINGDALE RD NE
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:
30306-4617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-373-5223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 HOLCOMB BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30092-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-449-5161
Provider Business Practice Location Address Fax Number:
770-449-3272
Provider Enumeration Date:
06/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ST CLAIR
Authorized Official First Name:
JANE
Authorized Official Middle Name:
TURLEY
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
404-607-9737

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X , with the licence number:  24485 , 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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