1831186857 NPI number — BARBARA MCMILLAN-PERSAUD M.D

Table of content: BARBARA MCMILLAN-PERSAUD M.D (NPI 1831186857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831186857 NPI number — BARBARA MCMILLAN-PERSAUD M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMILLAN-PERSAUD
Provider First Name:
BARBARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1831186857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1046 RIDGE AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30315-1640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-688-1350
Provider Business Mailing Address Fax Number:
404-688-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 E. CLEVELAND AVE.
Provider Second Line Business Practice Location Address:
BLDG. 500
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30334-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-752-1000
Provider Business Practice Location Address Fax Number:
404-688-2962
Provider Enumeration Date:
10/04/2005

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:  046887 , 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: 000848383B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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