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General NPI Number Information
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NPI Number | 1659233435
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Entity Type | Organization
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Legal Business Name | ROOTS & RIDGE
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 756 PARDUE RD
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City | SPARTA
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State | NC
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Zip | 28675-8693
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Country | US
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Telephone | 336-520-8570
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Fax |
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Provider Business Mailing Address
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Address Line | 756 PARDUE RD
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City | SPARTA
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State | NC
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Zip | 28675-8693
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Country | US
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Telephone | 336-520-8570
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/PRACTICE MANAGER
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Name | MRS. TIFFANY PAIGE HAMM-GENTRY
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Credential |
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Telephone | 336-520-8570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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