1750527909 NPI number — ATTAIN MED, INC.

Table of content: (NPI 1750527909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750527909 NPI number — ATTAIN MED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATTAIN MED, 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:
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:
1750527909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5825 GLENRIDGE DR NE
Provider Second Line Business Mailing Address:
BUILDING 4, SUITE 106
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30328-5387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-288-2466
Provider Business Mailing Address Fax Number:
888-288-2181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5825 GLENRIDGE DR NE
Provider Second Line Business Practice Location Address:
BUILDING 4, SUITE 106
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-5387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-288-2466
Provider Business Practice Location Address Fax Number:
888-288-2181
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
LEONARDO
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
404-432-9885

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1519158 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 502235656A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 502235656B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52227848001 . This is a "BLUE CROSS BLUE SHIELD OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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