=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871659342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHYLLIS ARMSTEAD BAEZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 05/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 VANCE ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28328-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-567-6194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 TAYSIDE ST
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520-8724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-850-9927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 009900755
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------