1689787533 NPI number — LINDA ROYAL R.N., F.N.P.

Table of content: LINDA ROYAL R.N., F.N.P. (NPI 1689787533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689787533 NPI number — LINDA ROYAL R.N., F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROYAL
Provider First Name:
LINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N., F.N.P.
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:
1689787533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1028460
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-501-7969
Provider Business Mailing Address Fax Number:
404-501-6638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2665 N DECATUR RD
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-6149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-501-2927
Provider Business Practice Location Address Fax Number:
404-501-7644
Provider Enumeration Date:
08/16/2006

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: 363LF0000X , with the licence number:  077505 , 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: 456100341B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 456100341A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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