1972825990 NPI number — DR. GWENETH MALICIA FRANCIS D.O.

Table of content: DR. GWENETH MALICIA FRANCIS D.O. (NPI 1972825990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972825990 NPI number — DR. GWENETH MALICIA FRANCIS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRANCIS
Provider First Name:
GWENETH
Provider Middle Name:
MALICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1972825990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 COLLIER RD NW
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-355-3161
Provider Business Mailing Address Fax Number:
404-355-1353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 HIGHWAY 54 W
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-4548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-435-3044
Provider Business Practice Location Address Fax Number:
678-435-3040
Provider Enumeration Date:
02/17/2010

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: 207RI0200X , with the licence number:  068157 , 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: GA1350 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003126922A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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