=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124169263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALBEMARLE BEHAVIORAL MEDICINE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 E MAIN ST SUITE 202
-----------------------------------------------------
City | ELIZABETH CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27909-4495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-338-0121
-----------------------------------------------------
Fax | 252-338-0811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 E MAIN ST SUITE 202
-----------------------------------------------------
City | ELIZABETH CITY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27909-4495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-338-0121
-----------------------------------------------------
Fax | 252-338-0811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. BARBARA ANN SAWYER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 252-338-0121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | NC9500212
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------