Healthcare Provider Details

I. General information

NPI: 1144533944
Provider Name (Legal Business Name): GERIATRIC NEUROPSYCHIATRY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 SKY LANE DR
DURHAM NC
27704-3953
US

IV. Provider business mailing address

PO BOX 61447
DURHAM NC
27715-1447
US

V. Phone/Fax

Practice location:
  • Phone: 919-682-0323
  • Fax: 919-687-7649
Mailing address:
  • Phone: 919-682-0323
  • Fax: 919-687-7649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT E WILLIAMS
Title or Position: OWNER
Credential: M.D.
Phone: 919-682-0323