1578079000 NPI number — PIEDMONT ATHENS HOSPITALIST PHYSICIANS LLC

Table of content: (NPI 1578079000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578079000 NPI number — PIEDMONT ATHENS HOSPITALIST PHYSICIANS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIEDMONT ATHENS HOSPITALIST PHYSICIANS LLC
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:
1578079000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 117265
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:
30368-7265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-801-2500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 COLLIER RD NW STE 635
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-367-3014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2017

Additional Information

Authorized Official

Authorized Official Last Name:
AQUINO
Authorized Official First Name:
CHRISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official Telephone Number:
470-271-3427

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003208684A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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