Provider Demographics
NPI:1801932199
Name:PLANNED PARENTHOOD SOUTH ATLANTIC
Entity type:Organization
Organization Name:PLANNED PARENTHOOD SOUTH ATLANTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:TEARRA
Authorized Official - Middle Name:ALEXANDRIA
Authorized Official - Last Name:RAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-833-7526
Mailing Address - Street 1:100 S BOYLAN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1802
Mailing Address - Country:US
Mailing Address - Phone:919-833-7534
Mailing Address - Fax:919-833-0730
Practice Address - Street 1:522 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2169
Practice Address - Country:US
Practice Address - Phone:304-295-3331
Practice Address - Fax:304-295-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008073000Medicaid