Basic Information
| Provider Information | |||||||||
| NPI: | 1669654034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 24 ON PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 403631 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303843631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707400895 | ||||||||
| FaxNumber: | 7707400896 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 GARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261015340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044207161 | ||||||||
| FaxNumber: | 3044207162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2007 | ||||||||
| LastUpdateDate: | 11/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | FULLER | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 7707400895 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.