1275664534 NPI number — JANET STEPHENS BANKS M.A.

Table of content: JANET STEPHENS BANKS M.A. (NPI 1275664534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275664534 NPI number — JANET STEPHENS BANKS M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANKS
Provider First Name:
JANET
Provider Middle Name:
STEPHENS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1275664534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 NICOLE TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT HOLLY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28120-9603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-263-2669
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001-3939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-982-9600
Provider Business Practice Location Address Fax Number:
704-982-8155
Provider Enumeration Date:
03/08/2007

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: 103TC0700X , with the licence number:  1897 , 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: 3408844 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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