1225134323 NPI number — ALFRED BOYD LITTLE MD FACC

Table of content: ALFRED BOYD LITTLE MD FACC (NPI 1225134323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225134323 NPI number — ALFRED BOYD LITTLE MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLE
Provider First Name:
ALFRED
Provider Middle Name:
BOYD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
Provider Gender Code:
M

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:
1225134323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 NORTHLINE AVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27408-7616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-273-7900
Provider Business Mailing Address Fax Number:
336-273-8147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 NORTHLINE AVE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-7616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-273-7900
Provider Business Practice Location Address Fax Number:
336-273-8147
Provider Enumeration Date:
09/15/2006

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: 207RC0000X , with the licence number:  23900 , 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)

  • Identifier: 8952112 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52112 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".