1689770414 NPI number — DENIS MORIN

Table of content: RYAN PAUL LARUE LMSW (NPI 1902904188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689770414 NPI number — DENIS MORIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENIS MORIN
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:
6
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:
1689770414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 BUCHANAN BYP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUCHANAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30113-4924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-646-8281
Provider Business Mailing Address Fax Number:
770-646-3579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 BUCHANAN BYP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCHANAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30113-4924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-646-8281
Provider Business Practice Location Address Fax Number:
770-646-3579
Provider Enumeration Date:
09/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COGGINS
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
770-824-2854

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  024466 , 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)