Healthcare Provider Details

I. General information

NPI: 1841999729
Provider Name (Legal Business Name): MARION LOUISE GADDY PHLEBOTOMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DAVIS ST STE C
ASHEBORO NC
27203-5485
US

IV. Provider business mailing address

111 DAVIS ST STE C
ASHEBORO NC
27203-5485
US

V. Phone/Fax

Practice location:
  • Phone: 336-267-6428
  • Fax: 336-521-4020
Mailing address:
  • Phone: 336-267-6428
  • Fax: 336-521-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: