Healthcare Provider Details

I. General information

NPI: 1275614430
Provider Name (Legal Business Name): SANDHILLS NEPHROLOGY AND INTERNAL MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 WALTER REED RD
FAYETTEVILLE NC
28304-4440
US

IV. Provider business mailing address

1218 WALTER REED RD
FAYETTEVILLE NC
28304-4440
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-1671
  • Fax: 910-323-9656
Mailing address:
  • Phone: 910-323-1671
  • Fax: 910-323-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MILDRED ENID ROMEU
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-323-1671