Healthcare Provider Details

I. General information

NPI: 1083579486
Provider Name (Legal Business Name): ULYSSIA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 REID RD
GARYSBURG NC
27831-9698
US

IV. Provider business mailing address

229 REID RD
GARYSBURG NC
27831-9698
US

V. Phone/Fax

Practice location:
  • Phone: 252-554-9626
  • Fax:
Mailing address:
  • Phone: 252-554-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: