Healthcare Provider Details

I. General information

NPI: 1477240711
Provider Name (Legal Business Name): RDMG ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 STONEHENGE DR STE 200
RALEIGH NC
27613-1649
US

IV. Provider business mailing address

PO BOX 63103
CHARLOTTE NC
28263-3103
US

V. Phone/Fax

Practice location:
  • Phone: 919-410-7083
  • Fax:
Mailing address:
  • Phone: 919-233-5952
  • Fax: 312-324-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MOYE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-614-0301