1790288587 NPI number — ACC3 INTERNATIONAL, INC.

Table of content: (NPI 1790288587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790288587 NPI number — ACC3 INTERNATIONAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACC3 INTERNATIONAL, 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:
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:
1790288587
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13446 POWAY RD # 239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWAY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92064-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3340 PEACHTREE RD NE STE 2025
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:
30326-1084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-467-9890
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MALLIK
Authorized Official First Name:
RAVI
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT HEALTHCARE DIVISION
Authorized Official Telephone Number:
404-441-6522

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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