1922793686 NPI number — INNOVATIVE OPTIONS INCORPORATED

Table of content: (NPI 1922793686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922793686 NPI number — INNOVATIVE OPTIONS INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE OPTIONS INCORPORATED
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:
1922793686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3915 CASCADE RD SW STE T-138
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:
30331-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-237-8460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1216 GRANBY ST STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23510-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-237-8460
Provider Business Practice Location Address Fax Number:
478-288-7832
Provider Enumeration Date:
04/10/2023

Additional Information

Authorized Official

Authorized Official Last Name:
THORNTON
Authorized Official First Name:
ANTOINETTE
Authorized Official Middle Name:
NUMITAL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
757-237-8460

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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