Healthcare Provider Details

I. General information

NPI: 1114454295
Provider Name (Legal Business Name): GINA ELIZABETH BOTZIS MS/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 JOHN KNOX DR
COLFAX NC
27235-9662
US

IV. Provider business mailing address

113 S RAILROAD AVE
DUNN NC
28334-4853
US

V. Phone/Fax

Practice location:
  • Phone: 336-668-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4979
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: