Provider Demographics
NPI:1003621350
Name:ROBERTS, FRANKIE ALFONZO
Entity type:Individual
Prefix:
First Name:FRANKIE
Middle Name:ALFONZO
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HARGROVE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9081
Mailing Address - Country:US
Mailing Address - Phone:910-262-1600
Mailing Address - Fax:910-332-1145
Practice Address - Street 1:929 N FRONT ST # 435
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3599
Practice Address - Country:US
Practice Address - Phone:910-262-1600
Practice Address - Fax:910-332-1145
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1383172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker