1841495413 NPI number — DR. GEORGE DEMARIS GRESSMAN III PSY.D.

Table of content: DR. GEORGE DEMARIS GRESSMAN III PSY.D. (NPI 1841495413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841495413 NPI number — DR. GEORGE DEMARIS GRESSMAN III PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRESSMAN
Provider First Name:
GEORGE
Provider Middle Name:
DEMARIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PSY.D.
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:
1841495413
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4093 DOODLEBUG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-9426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-521-6202
Provider Business Mailing Address Fax Number:
910-521-6786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 UNIVERSITY RD
Provider Second Line Business Practice Location Address:
UNCP COUNSELING & TESTING CENTER
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-8699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-521-6202
Provider Business Practice Location Address Fax Number:
910-521-6786
Provider Enumeration Date:
06/15/2007

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: 101YP2500X , with the licence number:  685 , 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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