1790717171 NPI number — LINDA L CASTEEL MD

Table of content: LINDA L CASTEEL MD (NPI 1790717171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790717171 NPI number — LINDA L CASTEEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTEEL
Provider First Name:
LINDA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1790717171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1976 MAIN ST E
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30078-6460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-979-1818
Provider Business Mailing Address Fax Number:
770-736-7134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1976 MAIN ST E
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30078-6460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-982-0283
Provider Business Practice Location Address Fax Number:
770-609-8443
Provider Enumeration Date:
07/07/2006

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: 207Q00000X , with the licence number:  043346 , 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: 000755741B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com