1699041160 NPI number — MRS. SARAH E WHITEHEAD MD

Table of content: MRS. SARAH E WHITEHEAD MD (NPI 1699041160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699041160 NPI number — MRS. SARAH E WHITEHEAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITEHEAD
Provider First Name:
SARAH
Provider Middle Name:
E
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDDING
Provider Other First Name:
SARAH
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699041160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743294
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-716-3346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PARIS VIEW FAMILY MEDICINE
Provider Second Line Business Practice Location Address:
1028 NORTH CHURCH STREET
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29601-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-271-1464
Provider Business Practice Location Address Fax Number:
877-379-2854
Provider Enumeration Date:
03/28/2012

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: 207QG0300X , with the licence number:  52015 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 520145 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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