1730382821 NPI number — JEREMY TODD ROYAL M.D.

Table of content: EMILY ROSENFELD M.D. (NPI 1700230695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730382821 NPI number — JEREMY TODD ROYAL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROYAL
Provider First Name:
JEREMY
Provider Middle Name:
TODD
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1730382821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5605 GLENRIDGE DR STE 325
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:
30342-1365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-553-7783
Provider Business Mailing Address Fax Number:
678-553-7793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 JOHNSON FERRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-851-6323
Provider Business Practice Location Address Fax Number:
404-303-3747
Provider Enumeration Date:
06/07/2007

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: 2085R0202X , with the licence number:  28589 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD36307 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 67312 , 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: 051116335 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 129081 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116340 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051116342 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051116344 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 129079 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129080 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129084 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116334 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 129088 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116336 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051116341 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051116333 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 129087 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116343 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 06104821 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129082 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129086 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051116339 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 129083 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com