1750601308 NPI number — MR. FRANK GRAHAM PRATT III LCSW

Table of content: MR. FRANK GRAHAM PRATT III LCSW (NPI 1750601308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750601308 NPI number — MR. FRANK GRAHAM PRATT III LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRATT
Provider First Name:
FRANK
Provider Middle Name:
GRAHAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
LCSW
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:
1750601308
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 JOHN MADDOX DR NW
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30165-1451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-234-0034
Provider Business Mailing Address Fax Number:
706-234-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 N 5TH AVE NE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30165-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-234-0034
Provider Business Practice Location Address Fax Number:
678-348-7595
Provider Enumeration Date:
06/06/2010

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: 1041C0700X , with the licence number:  CSW004202 , 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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