Provider Demographics
NPI:1871752105
Name:RALEIGH PROFESSIONAL ASSOCIATES
Entity type:Organization
Organization Name:RALEIGH PROFESSIONAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-372-7878
Mailing Address - Street 1:1869 HIGHWAY 45 BYP
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2464
Mailing Address - Country:US
Mailing Address - Phone:731-660-0880
Mailing Address - Fax:731-668-0380
Practice Address - Street 1:1869 HIGHWAY 45 BYP
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2464
Practice Address - Country:US
Practice Address - Phone:731-660-0880
Practice Address - Fax:731-668-0380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RALEIGH PROFESSIONAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000036261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone