Healthcare Provider Details

I. General information

NPI: 1932225638
Provider Name (Legal Business Name): ROBERT L. GROOMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MEMORIAL DRIVE
PINEHURST NC
28370
US

IV. Provider business mailing address

1120 7 LKS N PO BOX 9
WEST END NC
27376-9756
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-6853
  • Fax: 910-295-9183
Mailing address:
  • Phone: 910-673-9111
  • Fax: 910-673-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: