1952482135 NPI number — DR. NANDLAL CHAINANI M.D.

Table of content: DR. NANDLAL CHAINANI M.D. (NPI 1952482135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952482135 NPI number — DR. NANDLAL CHAINANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAINANI
Provider First Name:
NANDLAL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1952482135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1610 JOHN ORR DR
Provider Second Line Business Mailing Address:
BLDG E
Provider Business Mailing Address City Name:
TIFTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31794-3682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-386-5101
Provider Business Mailing Address Fax Number:
229-468-5526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 JOHN ORR DR
Provider Second Line Business Practice Location Address:
BLDG E
Provider Business Practice Location Address City Name:
TIFTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31794-3682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-386-5101
Provider Business Practice Location Address Fax Number:
229-386-2277
Provider Enumeration Date:
10/17/2006

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: 208000000X , with the licence number:  044893 , 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: 336168 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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