1639414022 NPI number — ALLIED HEALTH SERVICES GEORGIA

Table of content: CAROL JEAN TIPTON RN (NPI 1841057825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639414022 NPI number — ALLIED HEALTH SERVICES GEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED HEALTH SERVICES GEORGIA
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:
1639414022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 OLD NATIONAL HWY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30349-3356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-763-0055
Provider Business Mailing Address Fax Number:
404-763-0058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5530 OLD NATIONAL HWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30349-3356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-763-0055
Provider Business Practice Location Address Fax Number:
404-763-0058
Provider Enumeration Date:
12/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KARGBO
Authorized Official First Name:
KALIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO & PRESIDENT
Authorized Official Telephone Number:
404-763-0055

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  060-R-0952 , 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)





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