1902952625 NPI number — RL BROWN JR GRADY HEALTH CENTER AT HARTSFIELD JACKSON AIRPORT

Table of content: LYNDSEY JANE HARTLINE RBT (NPI 1841855392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902952625 NPI number — RL BROWN JR GRADY HEALTH CENTER AT HARTSFIELD JACKSON AIRPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RL BROWN JR GRADY HEALTH CENTER AT HARTSFIELD JACKSON AIRPORT
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:
1902952625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 JESSE HILL JR DR SE
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:
30303-3031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-616-6000
Provider Business Mailing Address Fax Number:
404-768-3990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 NORTH TERMINAL PARKWAY
Provider Second Line Business Practice Location Address:
ATRIUM SUITE 375
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-616-6000
Provider Business Practice Location Address Fax Number:
404-768-3990
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
404-616-4930

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  060-069 , 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: 987203 . This is a "COVENTRY PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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