1316014897 NPI number — MRS. TAMMY HARRIS SYKES CDA

Table of content: MRS. TAMMY HARRIS SYKES CDA (NPI 1316014897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316014897 NPI number — MRS. TAMMY HARRIS SYKES CDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYKES
Provider First Name:
TAMMY
Provider Middle Name:
HARRIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CDA
Provider Gender Code:
F

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:
1316014897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W TRYON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27278-2438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-245-2435
Provider Business Mailing Address Fax Number:
919-644-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N GREENSBORO ST
Provider Second Line Business Practice Location Address:
CARR MILL MALL SUITE D15
Provider Business Practice Location Address City Name:
CARRBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27510-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-968-2040
Provider Business Practice Location Address Fax Number:
919-968-2021
Provider Enumeration Date:
11/29/2006

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: 126800000X , with the licence number:  133902 , 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: 3404475 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07146 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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