1124210554 NPI number — SUSAN EDITH EVERS P.A.

Table of content: SUSAN EDITH EVERS P.A. (NPI 1124210554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124210554 NPI number — SUSAN EDITH EVERS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVERS
Provider First Name:
SUSAN
Provider Middle Name:
EDITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVERS
Provider Other First Name:
EDITH
Provider Other Middle Name:
LYDIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124210554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 EAST MAIN STREET
Provider Second Line Business Mailing Address:
ALBEMARLE MENTAL HEALTH CENTER P.O. BOX 2367
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27906-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-335-0803
Provider Business Mailing Address Fax Number:
252-335-9143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 W LIBERTY ST
Provider Second Line Business Practice Location Address:
ALBEMARLE MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
WILLIAMSTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27892-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-792-5151
Provider Business Practice Location Address Fax Number:
252-792-0802
Provider Enumeration Date:
08/09/2007

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: 363A00000X , with the licence number:  103567 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)