1548206295 NPI number — PASCAL GEORGE CROSLEY D.O

Table of content: PASCAL GEORGE CROSLEY D.O (NPI 1548206295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548206295 NPI number — PASCAL GEORGE CROSLEY D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROSLEY
Provider First Name:
PASCAL
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
M

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:
1548206295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 POWELL STREET
Provider Second Line Business Mailing Address:
STE 920
Provider Business Mailing Address City Name:
EMERYVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94608-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-350-2600
Provider Business Mailing Address Fax Number:
510-879-9100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 DEKALB MEDICAL PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-501-8700
Provider Business Practice Location Address Fax Number:
404-501-5093
Provider Enumeration Date:
06/21/2006

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: 207P00000X , with the licence number:  054481 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 25MB10118500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 601790765E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com