1992902357 NPI number — DR. DANA G PICCIRILLO D.C

Table of content: JILLIAN R O'BRIEN OTR/L (NPI 1386740777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992902357 NPI number — DR. DANA G PICCIRILLO D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PICCIRILLO
Provider First Name:
DANA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
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:
1992902357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2181 NORTHLAKE PWKY
Provider Second Line Business Mailing Address:
BUILDING 6 SUITE 120
Provider Business Mailing Address City Name:
TUCKER
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30084
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-934-4233
Provider Business Mailing Address Fax Number:
770-934-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2181 NORTHLAKE PKWY
Provider Second Line Business Practice Location Address:
BUILDING 6 SUITE 120
Provider Business Practice Location Address City Name:
TUCKER
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30084-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-934-4233
Provider Business Practice Location Address Fax Number:
770-934-4234
Provider Enumeration Date:
06/29/2007

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: 111NR0400X , with the licence number:  CHIR007460 , 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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