Provider Demographics
NPI:1952833014
Name:SOLOMON, ALEXIS (LAT, ATC, AEMT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LAT, ATC, AEMT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC, AEMT
Mailing Address - Street 1:1909 CHAVIS CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-565-8812
Practice Address - Fax:252-565-8814
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-30242255A2300X
NCP115261146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate