Provider Demographics
NPI:1457451288
Name:GOBBLE, ADELE R (DIETITION)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:R
Last Name:GOBBLE
Suffix:
Gender:F
Credentials:DIETITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SPICEWOOD LANE RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779
Mailing Address - Country:US
Mailing Address - Phone:828-586-7000
Mailing Address - Fax:
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
NCL002070133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00246OtherBC FOR HARRIS
NCL002070OtherLICENSE
NC00540OtherBC FOR SWAIN
NC235016Medicare ID - Type UnspecifiedHARRIS MEDICARE GROUP
NC00246OtherBC FOR HARRIS
NC235131BMedicare ID - Type UnspecifiedSWAIN MEDICARE GROUP