1639191646 NPI number — ALAN S BANKS DPM

Table of content: ALAN S BANKS DPM (NPI 1639191646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639191646 NPI number — ALAN S BANKS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANKS
Provider First Name:
ALAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1639191646
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 CHARLOTTE AVE STE F185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37209-4066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-426-2171
Provider Business Mailing Address Fax Number:
615-269-3087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2295 PARKLAKE DR NE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30345-2825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-938-5974
Provider Business Practice Location Address Fax Number:
770-939-7393
Provider Enumeration Date:
07/25/2006

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: 213E00000X , with the licence number:  545 , 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: 048552 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480018110 . This is a "MCR RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000356771D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 518114 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00370534 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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