1649467259 NPI number — ELIZABETH A STRICKLER PHD PC

Table of content: (NPI 1649467259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649467259 NPI number — ELIZABETH A STRICKLER PHD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH A STRICKLER PHD PC
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:
1649467259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2761
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIRSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30514-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-781-6035
Provider Business Mailing Address Fax Number:
706-374-6451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
566 MURPHY HWY
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30512-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-781-6035
Provider Business Practice Location Address Fax Number:
706-374-6451
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRICKLER
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-781-6035

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY001183 , 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: 10058276 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 600006850 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PSY001183 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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