Healthcare Provider Details

I. General information

NPI: 1902018070
Provider Name (Legal Business Name): SANDHILLS ENT ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S LONG DR SUITE 203 B
ROCKINGHAM NC
28379-4874
US

IV. Provider business mailing address

921 S LONG DR SUITE 203 B
ROCKINGHAM NC
28379-4874
US

V. Phone/Fax

Practice location:
  • Phone: 910-417-3456
  • Fax: 910-417-3460
Mailing address:
  • Phone: 910-417-3456
  • Fax: 910-417-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: NELLIE MCCALLUM
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-417-3456