Basic Information
Provider Information
NPI: 1518199074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AUSTIN
FirstName: JULIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2968 GALLANT DR
Address2: APT. 7
City: BIRMINGHAM
State: AL
PostalCode: 352151798
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2250 HICKORY RD
Address2:  
City: PLYMOUTH MEETING
State: PA
PostalCode: 194621047
CountryCode: US
TelephoneNumber: 8008794471
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/18/2009
LastUpdateDate: 08/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246RP1900X  Y Technologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy

No ID Information.


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