1851687461 NPI number — MRS. KATHERINE SUZANNE HINES RD, LD, CDE

Table of content: MRS. KATHERINE SUZANNE HINES RD, LD, CDE (NPI 1851687461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851687461 NPI number — MRS. KATHERINE SUZANNE HINES RD, LD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINES
Provider First Name:
KATHERINE
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CDE
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:
1851687461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 MANCHESTER EXPRESSAY
Provider Second Line Business Mailing Address:
ST. FRANCIS HOSPITAL
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-257-7715
Provider Business Mailing Address Fax Number:
706-257-7716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3740 WOODRUFF ROAD
Provider Second Line Business Practice Location Address:
HEALTH MATTERS OF ST. FRANCIS
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-257-7715
Provider Business Practice Location Address Fax Number:
706-257-7716
Provider Enumeration Date:
06/22/2011

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: 133V00000X , with the licence number:  002144 , 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)





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