1043675259 NPI number — MRS. SALLIE GEER ROBERTS RD, LDN

Table of content: MRS. SALLIE GEER ROBERTS RD, LDN (NPI 1043675259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043675259 NPI number — MRS. SALLIE GEER ROBERTS RD, LDN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
SALLIE
Provider Middle Name:
GEER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LDN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GEER
Provider Other First Name:
SALLIE
Provider Other Middle Name:
WHITEFOORD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043675259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13625 FIRENZA CIR
Provider Second Line Business Mailing Address:
APARTMENT 104
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28273-4405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-276-2171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7810 BALLANTYNE COMMONS PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-995-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2015

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: 133V00000X , with the licence number:  L004796 , 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)





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