Healthcare Provider Details

I. General information

NPI: 1659233435
Provider Name (Legal Business Name): ROOTS & RIDGE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 S MAIN ST UNIT 206
SPARTA NC
28675-9618
US

IV. Provider business mailing address

2586 SCENIC VALLEY RD
GLADE VALLEY NC
28627-9491
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-1510
  • Fax: 336-372-1512
Mailing address:
  • Phone: 336-372-1510
  • Fax: 336-372-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY PAIGE HAMM-GENTRY
Title or Position: CO OWNER
Credential:
Phone: 336-372-1510