1609079771 NPI number — MS. SHELLEY KAYE DILLS MS, CGC

Table of content: MS. SHELLEY KAYE DILLS MS, CGC (NPI 1609079771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609079771 NPI number — MS. SHELLEY KAYE DILLS MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLS
Provider First Name:
SHELLEY
Provider Middle Name:
KAYE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
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:
1609079771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2040 BLUE IRIS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTHEWS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-275-4465
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 BLYTHE BLVD STE 200
Provider Second Line Business Practice Location Address:
CLINICAL GENETICS
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28203-5865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-381-6810
Provider Business Practice Location Address Fax Number:
704-381-6811
Provider Enumeration Date:
06/07/2007

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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