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

Table of content: DR. ATTICIA PARMER BUNDY PH.D. (NPI 1336478833)

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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