1659542165 NPI number — MISS REBECCA J BADACH PA

Table of content: MISS REBECCA J BADACH PA (NPI 1659542165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659542165 NPI number — MISS REBECCA J BADACH PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADACH
Provider First Name:
REBECCA
Provider Middle Name:
J
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1659542165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 CARLTON ST
Provider Second Line Business Mailing Address:
UGA, UNIVERISTY HEALTH CENTER
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30602-1755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-542-8636
Provider Business Mailing Address Fax Number:
706-542-0214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 CARLTON ST
Provider Second Line Business Practice Location Address:
UGA, UNIVERISTY HEALTH CENTER
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30602-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-542-8636
Provider Business Practice Location Address Fax Number:
706-542-0214
Provider Enumeration Date:
03/13/2008

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: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 004713 , 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: 30332876 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com