1750899738 NPI number — HARRISON JERRELL GUNN FNP

Table of content: HARRISON JERRELL GUNN FNP (NPI 1750899738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750899738 NPI number — HARRISON JERRELL GUNN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNN
Provider First Name:
HARRISON
Provider Middle Name:
JERRELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1750899738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 WESTVIEW DRIVE, SW
Provider Second Line Business Mailing Address:
HARRIS BUILDING, SUITE 100-A
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30310-1458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-756-1400
Provider Business Mailing Address Fax Number:
404-756-5274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 SPRINGDALE RODE, SW
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:
30315-7802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-8100
Provider Business Practice Location Address Fax Number:
404-756-5274
Provider Enumeration Date:
01/12/2018

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: 363LF0000X , with the licence number:  NCO000001 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: RN226903 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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