1790075117 NPI number — DR. BRIAN K. HOWARD P.C.

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 1790075117 NPI number — DR. BRIAN K. HOWARD P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. BRIAN K. HOWARD P.C.
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:
1790075117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1357 HEMBREE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-5722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-619-9566
Provider Business Mailing Address Fax Number:
770-619-9597

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1357 HEMBREE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-5722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-619-9566
Provider Business Practice Location Address Fax Number:
770-619-9597
Provider Enumeration Date:
04/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-619-9566

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  45244 , 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)

  • Identifier: P00042313 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00810235A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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