Healthcare Provider Details

I. General information

NPI: 1043675259
Provider Name (Legal Business Name): SALLIE GEER ROBERTS RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SALLIE WHITEFOORD GEER

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 BALLANTYNE COMMONS PKWY SUITE 200
CHARLOTTE NC
28277-3415
US

IV. Provider business mailing address

13625 FIRENZA CIR APARTMENT 104
CHARLOTTE NC
28273-4405
US

V. Phone/Fax

Practice location:
  • Phone: 704-995-3434
  • Fax:
Mailing address:
  • Phone: 864-276-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004796
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: