Provider Demographics
NPI:1881853117
Name:RALEIGH PROFESSIONAL ASSOCIATES
Entity Type:Organization
Organization Name:RALEIGH PROFESSIONAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-372-7878
Mailing Address - Street 1:2960B AUSTIN PEAY HWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5602
Mailing Address - Country:US
Mailing Address - Phone:901-372-7878
Mailing Address - Fax:901-373-9298
Practice Address - Street 1:2960B AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5602
Practice Address - Country:US
Practice Address - Phone:901-372-7878
Practice Address - Fax:901-373-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000035261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone