1801926381 NPI number — SUMNER NEUROLOGY ASSOCIATES, PLLC

Table of content: (NPI 1801926381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801926381 NPI number — SUMNER NEUROLOGY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMNER NEUROLOGY ASSOCIATES, PLLC
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:
1801926381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 680010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30068-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-402-1053
Provider Business Mailing Address Fax Number:
678-402-5619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 JOHNSON FERRY RD BLDG F
Provider Second Line Business Practice Location Address:
STE.120
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30068-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-402-1053
Provider Business Practice Location Address Fax Number:
678-402-5619
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AHSAN
Authorized Official First Name:
JAWAID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
678-402-1053

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  16896 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 871643718A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 871643718A , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: FA1875624 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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