1770763427 NPI number — MR. CURRY JOSEPH BORDELON III PNP-AC

Table of content: MR. CURRY JOSEPH BORDELON III PNP-AC (NPI 1770763427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770763427 NPI number — MR. CURRY JOSEPH BORDELON III PNP-AC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORDELON
Provider First Name:
CURRY
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
PNP-AC
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:
1770763427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6687 GUNSTOCK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCKER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30084-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-362-6478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1968 PEACHTREE RD NW
Provider Second Line Business Practice Location Address:
PIEDMONT HOSPITAL, NICU
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-605-3568
Provider Business Practice Location Address Fax Number:
404-367-3565
Provider Enumeration Date:
11/10/2007

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: 363LN0000X , with the licence number:  RN157261 , 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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