Healthcare Provider Details

I. General information

NPI: 1881923464
Provider Name (Legal Business Name): SARA BROOKS ERICKSON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD STE 200
CHARLOTTE NC
28203-5865
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-8840
  • Fax:
Mailing address:
  • Phone: 704-512-4808
  • Fax: 704-512-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002373
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: