Provider Demographics
NPI:1295803864
Name:SANDHILLS NEUROLOGISTS, P.A.
Entity type:Organization
Organization Name:SANDHILLS NEUROLOGISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANJORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-235-0595
Mailing Address - Street 1:PO BOX 4005
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-4005
Mailing Address - Country:US
Mailing Address - Phone:910-235-0595
Mailing Address - Fax:910-235-0546
Practice Address - Street 1:295 OLMSTED BLVD
Practice Address - Street 2:MELLON BLDG. STE. 12
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9131
Practice Address - Country:US
Practice Address - Phone:910-235-0595
Practice Address - Fax:910-235-0546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011CTOtherBLUE CROSS BLUE SHIELD
NC89011CTMedicaid
NCCH0889OtherRAILROAD MEDICARE
NC89011CTMedicaid