Healthcare Provider Details

I. General information

NPI: 1558656702
Provider Name (Legal Business Name): DIABETES MANAGEMENT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NAVAHO DR STE 249
RALEIGH NC
27609-7364
US

IV. Provider business mailing address

1100 NAVAHO DR STE 249
RALEIGH NC
27609-7364
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-8466
  • Fax: 919-876-8465
Mailing address:
  • Phone: 919-876-8466
  • Fax: 919-876-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY C. HANCHETTE
Title or Position: CEO/FOUNDER
Credential: MED, CDE
Phone: 919-345-5074