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General NPI Number Information
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NPI Number | 1013644616
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Entity Type | Organization
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Legal Business Name | SLEEP & DIET RESTORATION PLLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 201 S MCPHERSON CHURCH RD STE 233
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4995
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Country | US
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Telephone | 910-212-6548
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S CHURCHILL DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5023
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Country | US
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Telephone | 910-322-1630
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Fax | 910-460-3967
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. LAURIE ANN POWERS
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Credential | PA-C
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Telephone | 910-212-6548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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