Provider Demographics
NPI:1649588997
Name:ROBERT TWADDELL
Entity Type:Organization
Organization Name:ROBERT TWADDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:TWADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-486-9511
Mailing Address - Street 1:1248 FORT BRAGG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4981
Mailing Address - Country:US
Mailing Address - Phone:910-486-9511
Mailing Address - Fax:910-728-4868
Practice Address - Street 1:1248 FORT BRAGG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-4981
Practice Address - Country:US
Practice Address - Phone:910-486-9511
Practice Address - Fax:910-728-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies