1124134010 NPI number — BROOKS BELLAMY MAYS MD

Table of content: (NPI 1982356580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124134010 NPI number — BROOKS BELLAMY MAYS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYS
Provider First Name:
BROOKS
Provider Middle Name:
BELLAMY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1124134010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 PAVILION WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28387-4561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-295-5511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PAVILION WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHERN PINES
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28387-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-295-5511
Provider Business Practice Location Address Fax Number:
910-235-3423
Provider Enumeration Date:
08/22/2006

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: 207RE0101X , with the licence number:  200601892 , 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: N01892 . This is a "SC MEDICAID PROVIDER #" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 5906374 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198833 . This is a "MEDCOST PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1446P . This is a "BCBS NC PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: FH2200320 . This is a "FIRSTCAROLINACARE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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