Basic Information
Provider Information | |||||||||
NPI: | 1568076222 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RALEIGH HOLISTIC HEALTHCARE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5109 SUNSET FAIRWAYS DR | ||||||||
Address2: |   | ||||||||
City: | HOLLY SPRINGS | ||||||||
State: | NC | ||||||||
PostalCode: | 275407862 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3367402160 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 875 WALNUT ST STE 275-9 | ||||||||
Address2: |   | ||||||||
City: | CARY | ||||||||
State: | NC | ||||||||
PostalCode: | 275114215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9197496288 | ||||||||
FaxNumber: | 9194431268 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2020 | ||||||||
LastUpdateDate: | 09/01/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DAVIS | ||||||||
AuthorizedOfficialFirstName: | NOVLET | ||||||||
AuthorizedOfficialMiddleName: | JARRETT | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 9197496288 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NOVLET DAVIS MD PLLC | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 09/01/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.