=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811033210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLANNED PARENTHOOD SOUTH ATLANTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 S BOYLAN AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27603-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-833-7526
-----------------------------------------------------
Fax | 919-390-1384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 S BOYLAN AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27603-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-833-7526
-----------------------------------------------------
Fax | 919-390-1384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REVENUE CYCLE
-----------------------------------------------------
Name | TEARRA ALEXANDRIA RAYNOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-833-7526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------