1770606501 NPI number — MRS. LEA HARRELL PUTNAM M.ED.

Table of content: MRS. LEA HARRELL PUTNAM M.ED. (NPI 1770606501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770606501 NPI number — MRS. LEA HARRELL PUTNAM M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUTNAM
Provider First Name:
LEA
Provider Middle Name:
HARRELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRELL
Provider Other First Name:
LEA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770606501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 AMERSHAM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLETCHER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28732-9244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-280-1305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 REDDICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28805-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-298-0186
Provider Business Practice Location Address Fax Number:
828-298-4870
Provider Enumeration Date:
04/08/2007

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: 101YP2500X , with the licence number:  4664 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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