1578651782 NPI number — DR. DALE R ERWIN M.D.

Table of content: DR. DALE R ERWIN M.D. (NPI 1578651782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578651782 NPI number — DR. DALE R ERWIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERWIN
Provider First Name:
DALE
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1578651782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2438
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30503-2438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-531-2444
Provider Business Mailing Address Fax Number:
770-534-9877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 JESSE JEWELL PKWY SE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-531-2444
Provider Business Practice Location Address Fax Number:
770-534-9877
Provider Enumeration Date:
10/11/2006

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: 2085R0202X , with the licence number:  028974 , 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)

  • Identifier: 000466331E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578651782 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 89066X5 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP7496 . This is a "MEDICARE GRP PROV #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000466331F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1457553968 . This is a "RAILROAD MEDICARE GROUP NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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