1962166207 NPI number — GAM-MED PLLC

Table of content: (NPI 1962166207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962166207 NPI number — GAM-MED PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAM-MED PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1962166207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 FOY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-2418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-443-6440
Provider Business Mailing Address Fax Number:
252-443-6442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 FOY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKY MOUNT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27804-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-443-5723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FAYE
Authorized Official First Name:
SHEIK
Authorized Official Middle Name:
AMAT TIJAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
857-206-4067

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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