Healthcare Provider Details

I. General information

NPI: 1528197407
Provider Name (Legal Business Name): MS. SADIE GURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 HIGHLAND DR
WASHINGTON NC
27889-3424
US

IV. Provider business mailing address

1308 HIGHLAND DR
WASHINGTON NC
27889-3424
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-8061
  • Fax: 252-946-8078
Mailing address:
  • Phone: 252-946-8061
  • Fax: 252-946-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: