Healthcare Provider Details

I. General information

NPI: 1578813275
Provider Name (Legal Business Name): ANTHONY BERNARD GERALD RRT,RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 S RAEFORD RD
FAYETTEVILLE NC
28304-6162
US

IV. Provider business mailing address

7300 S RAEFORD RD
FAYETTEVILLE NC
28304-6162
US

V. Phone/Fax

Practice location:
  • Phone: 910-475-6421
  • Fax: 910-867-8343
Mailing address:
  • Phone: 910-475-6421
  • Fax: 910-867-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number6308
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: