1750661427 NPI number — CHMK AND ASSOCIATES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750661427 NPI number — CHMK AND ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHMK AND ASSOCIATES 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:
6
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:
1750661427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 SHILOH RD NW
Provider Second Line Business Mailing Address:
SUITE 1730
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-7147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-425-4240
Provider Business Mailing Address Fax Number:
770-425-1357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 SHILOH RD NW
Provider Second Line Business Practice Location Address:
SUITE 1730
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-7147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-425-4240
Provider Business Practice Location Address Fax Number:
770-425-1357
Provider Enumeration Date:
08/25/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEAUDRY
Authorized Official First Name:
CLAUDE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
770-425-4240

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  033R0009 , 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)