1952013690 NPI number — MRS. MARY COWLES ROCHNER RD, LD

Table of content: MRS. MARY COWLES ROCHNER RD, LD (NPI 1952013690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952013690 NPI number — MRS. MARY COWLES ROCHNER RD, LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCHNER
Provider First Name:
MARY
Provider Middle Name:
COWLES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COWLES
Provider Other First Name:
MARY 'ALLIE'
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952013690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 TULLIE RD NE # 8221B
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:
30329-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-693-0091
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 TULLIE RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30329-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-693-0091
Provider Business Practice Location Address Fax Number:
404-785-3876
Provider Enumeration Date:
12/14/2022

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:  LD005661 , 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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