1992734867 NPI number — HALL COUNTY GEORGIA

Table of content: (NPI 1992734867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992734867 NPI number — HALL COUNTY GEORGIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALL COUNTY GEORGIA
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:
6
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:
1992734867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 931136
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:
31193-1136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-531-6838
Provider Business Mailing Address Fax Number:
770-531-6845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 CRESCENT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30501-5079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-531-6835
Provider Business Practice Location Address Fax Number:
770-531-6845
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRICE
Authorized Official First Name:
CHRISTIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION CHIEF OF EMS
Authorized Official Telephone Number:
770-531-6838

Provider Taxonomy Codes

  • Taxonomy code: 341800000X , with the licence number:  06907 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 06907 , 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: 00236992A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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