1649577529 NPI number — MR. MICHAEL STUART PERRY M.A., L.P.C., N.C.C.

Table of content: MR. MICHAEL STUART PERRY M.A., L.P.C., N.C.C. (NPI 1649577529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649577529 NPI number — MR. MICHAEL STUART PERRY M.A., L.P.C., N.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
MICHAEL
Provider Middle Name:
STUART
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.P.C., N.C.C.
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:
1649577529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 GLYNN ST S
Provider Second Line Business Mailing Address:
STE 127#326
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-2077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-371-4803
Provider Business Mailing Address Fax Number:
678-723-0936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 WERNER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENOIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30276-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-371-4803
Provider Business Practice Location Address Fax Number:
678-723-0936
Provider Enumeration Date:
02/11/2011

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: 101YP2500X , with the licence number:  LPC007125 , 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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