1336478833 NPI number — DR. ATTICIA PARMER BUNDY PH.D.

Table of content: FASILAT OLASUMBO NP (NPI 1144036476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336478833 NPI number — DR. ATTICIA PARMER BUNDY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNDY
Provider First Name:
ATTICIA
Provider Middle Name:
PARMER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCATEE
Provider Other First Name:
ATTICIA
Provider Other Middle Name:
BUNDY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336478833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1891 CUDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLFAX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27235-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-272-8090
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 GREEN VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27408-7042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-379-0199
Provider Business Practice Location Address Fax Number:
336-574-1139
Provider Enumeration Date:
12/11/2009

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: 101YM0800X , with the licence number:  4312 , 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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