1619986254 NPI number — ANTHONY J. NEARY DC LLC

Table of content: (NPI 1619986254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619986254 NPI number — ANTHONY J. NEARY DC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY J. NEARY DC 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:
ALL ABOUT WELLNESS
Provider Other Organization Name Type Code:
3
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:
1619986254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1263 CROWN TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30062-3065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-992-1920
Provider Business Mailing Address Fax Number:
770-864-9682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6748 JAMESTOWN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-992-1920
Provider Business Practice Location Address Fax Number:
770-864-9628
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEARY
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
678-992-1920

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  005252 , 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: 202G704310 . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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