1881624278 NPI number — DR. ANDREA ELIZABETH ANDREWS M.D.

Table of content: DR. ANDREA ELIZABETH ANDREWS M.D. (NPI 1881624278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881624278 NPI number — DR. ANDREA ELIZABETH ANDREWS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
ANDREA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
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:
ANDREWS
Provider Other First Name:
ANDREA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881624278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 FIVE FORKS TRICKUM RD
Provider Second Line Business Mailing Address:
SUITE 220 GEORGIA FAMILY CARE, LLC
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30044-8182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-578-4983
Provider Business Mailing Address Fax Number:
678-578-4999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 FIVE FORKS TRICKUM RD STE 220
Provider Second Line Business Practice Location Address:
GEORGIA FAMILY CARE, LLC
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30044-8183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-205-4999
Provider Business Practice Location Address Fax Number:
678-205-4969
Provider Enumeration Date:
07/03/2006

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:  056954 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 29149 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 212066821H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212066821A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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