Provider Demographics
NPI:1336410521
Name:THE NORMAN ADD CENTER, PLLC
Entity Type:Organization
Organization Name:THE NORMAN ADD CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:SHADID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-310-4477
Mailing Address - Street 1:730 ASP AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4933
Mailing Address - Country:US
Mailing Address - Phone:405-310-4477
Mailing Address - Fax:405-310-4417
Practice Address - Street 1:730 ASP AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4933
Practice Address - Country:US
Practice Address - Phone:405-310-4477
Practice Address - Fax:405-310-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100228720BMedicaid
OK400522572Medicare PIN