Provider Demographics
NPI:1437354792
Name:SICKLE CELL DISEASE ASSOC. SOUTHERN PIEDMONT, INC.
Entity Type:Organization
Organization Name:SICKLE CELL DISEASE ASSOC. SOUTHERN PIEDMONT, INC.
Other - Org Name:SICKLE CELL REGIONAL NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMBRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:704-332-4184
Mailing Address - Street 1:821 BAXTER ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2733
Mailing Address - Country:US
Mailing Address - Phone:704-332-4184
Mailing Address - Fax:704-332-2246
Practice Address - Street 1:821 BAXTER ST
Practice Address - Street 2:SUITE 312
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2733
Practice Address - Country:US
Practice Address - Phone:704-332-4184
Practice Address - Fax:704-332-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3403460261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403460Medicaid