Provider Demographics
NPI:1811022411
Name:TIMMONS, VIVIAN LEE
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:LEE
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 HYDE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-3160
Mailing Address - Country:US
Mailing Address - Phone:336-226-6276
Mailing Address - Fax:336-227-3580
Practice Address - Street 1:2418 HYDE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-3160
Practice Address - Country:US
Practice Address - Phone:336-226-6276
Practice Address - Fax:336-227-3580
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist