1902908536 NPI number — W. JOSEPH ABSI MD

Table of content: W. JOSEPH ABSI MD (NPI 1902908536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902908536 NPI number — W. JOSEPH ABSI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABSI
Provider First Name:
W.
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1902908536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4485 S COBB DR SE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-6957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-768-1133
Provider Business Mailing Address Fax Number:
404-768-0309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4485 S COBB DR SE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-768-1133
Provider Business Practice Location Address Fax Number:
404-768-0309
Provider Enumeration Date:
09/03/2006

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: 207XX0005X , with the licence number:  044661 , 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: 200044916 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52702670005 . This is a "BLUE CROSS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4190057 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 7439027 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0902271 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 174249 . This is a "COVENTRY HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 7102000GA30344 . This is a "BLUE CROSS OF MI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1871776922 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 361770600 . This is a "DEPT OF LABOR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 309294 . This is a "WELL CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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