1700887437 NPI number — DR. JAMES RICHARD BLAND II M.D.

Table of content: DR. JAMES RICHARD BLAND II M.D. (NPI 1700887437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700887437 NPI number — DR. JAMES RICHARD BLAND II M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAND
Provider First Name:
JAMES
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
M.D.
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:
1700887437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 AMBULANCE DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30117-3857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-838-8787
Provider Business Mailing Address Fax Number:
770-838-8922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 CLINIC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30117-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-836-9824
Provider Business Practice Location Address Fax Number:
770-836-9850
Provider Enumeration Date:
08/03/2005

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: 2085R0001X , with the licence number:  028727 , 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: 000328402C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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