Healthcare Provider Details

I. General information

NPI: 1275429557
Provider Name (Legal Business Name): TAMIKA SOMMERVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 ROPER SPRINGS RD
LITTLETON NC
27850-8659
US

IV. Provider business mailing address

207 W MILLBROOK RD
RALEIGH NC
27609-4393
US

V. Phone/Fax

Practice location:
  • Phone: 252-578-6163
  • Fax:
Mailing address:
  • Phone: 810-213-2569
  • Fax: 984-203-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: