Healthcare Provider Details

I. General information

NPI: 1699275123
Provider Name (Legal Business Name): JULIA BUMPUS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 12/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 MARTIN LUTHER KING PKWY
DURHAM NC
27707-6336
US

IV. Provider business mailing address

10900 WORLD TRADE BLVD
RALEIGH NC
27617-4202
US

V. Phone/Fax

Practice location:
  • Phone: 919-748-4990
  • Fax: 919-748-4991
Mailing address:
  • Phone: 336-549-3034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL004438
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: