1982749107 NPI number — SUSAN MCCARTHY FURMAN, PH.D., LLC

Table of content: (NPI 1982749107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982749107 NPI number — SUSAN MCCARTHY FURMAN, PH.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN MCCARTHY FURMAN, PH.D., LLC
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:
1982749107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30030-1870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-992-0705
Provider Business Mailing Address Fax Number:
404-377-6798

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30030-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-992-0705
Provider Business Practice Location Address Fax Number:
404-377-6798
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FURMAN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
MCCARTHY
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
404-992-0705

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY001568 , 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: A348376 . This is a "VALUE OPTIONS CHEVRON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 52060625 . This is a "BCBSGA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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