| Advaita Integrated Medicine Pllc | |
|
6112 Saint Giles St Raleigh NC 27612-7043 | |
| (919) 893-4465 | |
| Not Available |
| Full Name | Advaita Integrated Medicine Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6112 Saint Giles St, Raleigh, North Carolina |
| Authorized Official Name and Position | J Eulan Johnson (CEO) |
| Authorized Official Contact | 8282286148 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advaita Integrated Medicine Pllc 6112 Saint Giles St Raleigh NC 27612-7043 Ph: (919) 893-4465 | Advaita Integrated Medicine Pllc 6112 Saint Giles St Raleigh NC 27612-7043 Ph: (919) 893-4465 |
| NPI Number | 1437727088 |
|---|---|
| Provider Enumeration Date | 06/10/2021 |
| Last Update Date | 07/03/2024 |
| Certification Date | 07/03/2024 |
| Medicare PECOS PAC ID | 4385023043 |
|---|---|
| Medicare Enrollment ID | O20220627001513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437727088 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Caroline T Barndt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891136578 PECOS PAC ID: 2466763222 Enrollment ID: I20150619000979 |
| Provider Name | Mari-jane Shaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356718308 PECOS PAC ID: 6204123987 Enrollment ID: I20180110000564 |
| Provider Name | Roy Dewayne Book |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245437631 PECOS PAC ID: 1951648286 Enrollment ID: I20190124002596 |
| Provider Name | Corey C Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811410483 PECOS PAC ID: 8022340348 Enrollment ID: I20191105002818 |
| Provider Name | Timothy Joseph Oconnor |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285081711 PECOS PAC ID: 7113211442 Enrollment ID: I20200904000118 |
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