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General NPI Number Information
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NPI Number | 1710603014
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Entity Type | Organization
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Legal Business Name | SANDRA GAIL KOLB FAMILY PRACTICE
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 138 HUNTER CIR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3422
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Country | US
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Telephone | 910-339-4674
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Fax | 910-339-4676
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Provider Business Mailing Address
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Address Line | 138 HUNTER CIR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3422
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Country | US
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Telephone | 910-339-4674
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Fax | 910-339-4676
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Authorized Official
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Title or Position | PROVIDER
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Name | SANDRA KOLB
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Credential | NP-C
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Telephone | 910-339-4674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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