Provider Demographics
NPI:1639357569
Name:ATWELL, ROBERT SAGE (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SAGE
Last Name:ATWELL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3559
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-0859
Mailing Address - Country:US
Mailing Address - Phone:828-265-4370
Mailing Address - Fax:828-265-4354
Practice Address - Street 1:152 SOUTHGATE DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4959
Practice Address - Country:US
Practice Address - Phone:828-265-4370
Practice Address - Fax:828-265-4354
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist