1811276728 NPI number — MS. KISHA HASSANNA WHITFIELD M. ED.

Table of content: MS. KISHA HASSANNA WHITFIELD M. ED. (NPI 1811276728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811276728 NPI number — MS. KISHA HASSANNA WHITFIELD M. ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITFIELD
Provider First Name:
KISHA
Provider Middle Name:
HASSANNA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M. ED.
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:
1811276728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4916 LOCHERBY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBURN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30213-4383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-553-6871
Provider Business Mailing Address Fax Number:
678-818-4619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMETTO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30268-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-463-0202
Provider Business Practice Location Address Fax Number:
678-818-4619
Provider Enumeration Date:
08/09/2011

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: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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