1699762526 NPI number — NICHOLAS S. RANNO MD

Table of content: NICHOLAS S. RANNO MD (NPI 1699762526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699762526 NPI number — NICHOLAS S. RANNO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANNO
Provider First Name:
NICHOLAS
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699762526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3155 N POINT PKWY
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-645-9181
Provider Business Mailing Address Fax Number:
770-645-8455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 WINDY HILL RD SE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-574-0943
Provider Business Practice Location Address Fax Number:
678-574-0943
Provider Enumeration Date:
10/05/2005

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: 207L00000X , with the licence number:  28452 , 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: 000331724G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000331724L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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