Healthcare Provider Details

I. General information

NPI: 1265123699
Provider Name (Legal Business Name): ROBERT WILAN SICKLER III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 VILCOM CENTER DR STE 300
CHAPEL HILL NC
27514-1875
US

IV. Provider business mailing address

101 MANNING DRIVE ROOM 30319 CAMPUS BOX 7160
CHAPEL HILL NC
27599-7160
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-5217
  • Fax:
Mailing address:
  • Phone: 984-974-3881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024-02625
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL23-0104
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: