Provider Demographics
NPI:1013021377
Name:PLANNED PARENTHOOD SOUTH ATLANTIC
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD SOUTH ATLANTIC
Other - Org Name:PLANNED PARENTHOOD OF ORANGE & DURHAM COUNTIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TEARRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-833-7526
Mailing Address - Street 1:100 SOUTH BOYLAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1802
Mailing Address - Country:US
Mailing Address - Phone:919-833-7526
Mailing Address - Fax:919-390-1384
Practice Address - Street 1:1765 DOBBINS DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5876
Practice Address - Country:US
Practice Address - Phone:919-942-7762
Practice Address - Fax:919-933-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QA0005X
261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0258VOtherBCBS NORTH CAROLINA
NC890258UMedicaid
NC890258VMedicaid