1629406780 NPI number — UNIVERSITY OF NORTHGEORGIA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629406780 NPI number — UNIVERSITY OF NORTHGEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF NORTHGEORGIA
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:
6
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:
1629406780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82 COLLEGE CIRCLE
Provider Second Line Business Mailing Address:
HNS BUILDING, SUITE102
Provider Business Mailing Address City Name:
DAHLONEGA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30597-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-867-2713
Provider Business Mailing Address Fax Number:
706-867-3249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 COLLEGE CIRCLE
Provider Second Line Business Practice Location Address:
HNS BUILDING, SUITE102
Provider Business Practice Location Address City Name:
DAHLONEGA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30597-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-867-2713
Provider Business Practice Location Address Fax Number:
706-867-3249
Provider Enumeration Date:
10/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON-GALLOGLY
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PROJECT DIRECTOR
Authorized Official Telephone Number:
706-864-1934

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  113863 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 053488 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 169909 , 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: 539432806B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003132118A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003134646A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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