1700833159 NPI number — AFTER THE FALL INC.

Table of content: (NPI 1700833159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700833159 NPI number — AFTER THE FALL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFTER THE FALL INC.
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:
1700833159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4046 SHARPSBURG MCCULLUM RD STE 208B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWNAN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30265-2332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-497-0333
Provider Business Mailing Address Fax Number:
703-497-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4046 SHARPSBURG MCCULLUM RD STE 208B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-497-0333
Provider Business Practice Location Address Fax Number:
703-497-0377
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GLOVER
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-497-0333

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0002780 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010301157 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 773450000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE2620 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018225000001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138402 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: AS11468480001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41759900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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