Provider Demographics
NPI: | 1821793993 |
---|---|
Name: | SANDHILLS FUNCTIONAL MEDICINE PLLC |
Entity Type: | Organization |
Organization Name: | SANDHILLS FUNCTIONAL MEDICINE PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/FAMILY NURSE PRACTITIONER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | PAMELA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BENNETT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | FNP-C |
Authorized Official - Phone: | 910-986-6397 |
Mailing Address - Street 1: | 334 MILL CREEK RD STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | CARTHAGE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28327-6525 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-773-3889 |
Mailing Address - Fax: | 910-782-4077 |
Practice Address - Street 1: | 334 MILL CREEK RD STE B |
Practice Address - Street 2: | |
Practice Address - City: | CARTHAGE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28327-6525 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-773-3889 |
Practice Address - Fax: | 910-782-4077 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-03-30 |
Last Update Date: | 2023-03-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |