1821545997 NPI number — CORPORATE HEALTH PARTNERS, LLC

Table of content: (NPI 1821545997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821545997 NPI number — CORPORATE HEALTH PARTNERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORPORATE HEALTH PARTNERS, LLC
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:
1821545997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2105 BARRETT PARK DR NW
Provider Second Line Business Mailing Address:
STE106
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-7080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
675-486-8610
Provider Business Mailing Address Fax Number:
678-486-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 BARRETT PARK DR NW
Provider Second Line Business Practice Location Address:
STE106
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-7080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
675-486-8610
Provider Business Practice Location Address Fax Number:
678-848-6643
Provider Enumeration Date:
09/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
OBRIEN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
404-621-5556

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08BBSCZ . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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