1538483185 NPI number — STACI REBECCA PAYNE QUINTANA CD(DONA)

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538483185 NPI number — STACI REBECCA PAYNE QUINTANA CD(DONA)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINTANA
Provider First Name:
STACI REBECCA
Provider Middle Name:
PAYNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CD(DONA)
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:
1538483185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ILA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30647-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-296-4857
Provider Business Mailing Address Fax Number:
706-789-2578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
374 WESLEY CHAPEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANIELSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30633-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-296-4857
Provider Business Practice Location Address Fax Number:
706-789-2578
Provider Enumeration Date:
03/24/2010

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: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com