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General NPI Number Information
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NPI Number | 1598799728
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Entity Type | Individual
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Provider Name | VIVIAN DENISE EVERETT M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 01/13/2010
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Provider Practice Location Address
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Address Line | 1100 NAVAHO DR SUITE 121
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City | RALEIGH
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State | NC
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Zip | 27609-7319
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Country | US
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Telephone | 919-845-4620
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Fax | 919-846-8126
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Provider Business Mailing Address
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Address Line | PO BOX 1689
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City | ETOWAH
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State | NC
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Zip | 28729-1689
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Country | US
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Telephone | 828-891-5524
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Fax | 828-891-4069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 30019
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License Number State | NC
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