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General NPI Number Information
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NPI Number | 1114183548
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Entity Type | Organization
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Legal Business Name | SOUTHERN GERIATRICS, LLC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 1310 SE MAYNARD RD SUITE 202
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City | CARY
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State | NC
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Zip | 27511-3615
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Country | US
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Telephone | 919-463-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 SE MAYNARD RD SUITE 202
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City | CARY
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State | NC
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Zip | 27511-3615
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Country | US
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Telephone | 919-463-5600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID WESLEY LOEWY-
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Credential | PH.D
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Telephone | 919-463-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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