1841518784 NPI number — THE HIGHLAND CENTER

Table of content: MS. JUDITH B. GRACE L.C.P.C. (NPI 1265654156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841518784 NPI number — THE HIGHLAND CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HIGHLAND CENTER
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:
1841518784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31906-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-507-3274
Provider Business Mailing Address Fax Number:
706-653-2888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2324 FRANCIS ST STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31906-2564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-507-3274
Provider Business Practice Location Address Fax Number:
706-653-2888
Provider Enumeration Date:
05/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SLEDGE
Authorized Official First Name:
KAFFIE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
706-570-8290

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3707 , 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: 1285952218 . This is a "NPPES" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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