1548646409 NPI number — EASTERN ACUPUNCTURE & HERBAL CLINIC

Table of content: LINDSEY HANNAH DOUAN RN (NPI 1245901065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548646409 NPI number — EASTERN ACUPUNCTURE & HERBAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN ACUPUNCTURE & HERBAL CLINIC
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:
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:
1548646409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4651 ROSWELL RD
Provider Second Line Business Mailing Address:
BUILDING I SUITE-801
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-3048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-255-2558
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4651 ROSWELL RD
Provider Second Line Business Practice Location Address:
BUILDING I SUITE-801
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-3048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-255-2558
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LUO
Authorized Official First Name:
YONG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-255-2558

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  17 , 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)





Copyright © 2007-2025 www.npivalidator.com