1144668195 NPI number — PIONEER HEALTH SERVICES OF STOKES COUNTY, INC

Table of content: SARAH DEVANE ATWOOD LCSW (NPI 1578226601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144668195 NPI number — PIONEER HEALTH SERVICES OF STOKES COUNTY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEER HEALTH SERVICES OF STOKES COUNTY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1144668195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
167 MOORE RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
KING
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27021-8770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-983-6898
Provider Business Mailing Address Fax Number:
336-983-6921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
167 MOORE RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
KING
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27021-8770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-983-6898
Provider Business Practice Location Address Fax Number:
336-983-6921
Provider Enumeration Date:
06/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MCNULTY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
601-849-6440

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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