Healthcare Provider Details

I. General information

NPI: 1134214968
Provider Name (Legal Business Name): PLANNED PARENTHOOD SOUTH ATLANTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 PETERS CREEK RD NW
ROANOKE VA
24017
US

IV. Provider business mailing address

100 S BOYLAN AVE
RALEIGH NC
27603
US

V. Phone/Fax

Practice location:
  • Phone: 540-562-3457
  • Fax: 540-562-2735
Mailing address:
  • Phone: 919-833-7534
  • Fax: 919-833-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: TEARRA ALEXANDRIA RAYNOR
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 919-833-7526