1740262328 NPI number — DR. EVALIN RHODES HANSHEW PH.D.

Table of content: DR. EVALIN RHODES HANSHEW PH.D. (NPI 1740262328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740262328 NPI number — DR. EVALIN RHODES HANSHEW PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSHEW
Provider First Name:
EVALIN
Provider Middle Name:
RHODES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1740262328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 MOUNT PARAN RD NW
Provider Second Line Business Mailing Address:
MCCARTY BUILDING
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30327-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-233-3949
Provider Business Mailing Address Fax Number:
404-239-9460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 NORTHSIDE PKWY NW
Provider Second Line Business Practice Location Address:
BUILDING FOUR, SUITE 100
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30327-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-266-0695
Provider Business Practice Location Address Fax Number:
404-239-9460
Provider Enumeration Date:
11/18/2005

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: 103TC1900X , with the licence number:  PSY 002301 , 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)





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