Healthcare Provider Details

I. General information

NPI: 1801932199
Provider Name (Legal Business Name): PLANNED PARENTHOOD SOUTH ATLANTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 GRAND CENTRAL AVE
VIENNA WV
26105-2169
US

IV. Provider business mailing address

100 S BOYLAN AVE
RALEIGH NC
27603-1802
US

V. Phone/Fax

Practice location:
  • Phone: 304-295-3331
  • Fax: 304-295-4924
Mailing address:
  • Phone: 919-833-7534
  • Fax: 919-833-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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