1326202193 NPI number — W ALEXANDRA DA SOUZA MD PC

Table of content: (NPI 1326202193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326202193 NPI number — W ALEXANDRA DA SOUZA MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W ALEXANDRA DA SOUZA MD PC
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:
1326202193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 ANDREWS WAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
KINGSLAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31548-6860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-510-9100
Provider Business Mailing Address Fax Number:
912-510-9269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 ANDREWS WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KINGSLAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31548-6860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-510-9100
Provider Business Practice Location Address Fax Number:
912-510-9269
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DA SOUZA
Authorized Official First Name:
W
Authorized Official Middle Name:
ALEXANDRA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
912-510-9100

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  042556 , 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)





Copyright © 2007-2024 www.npivalidator.com