| Geode Health Of North Carolina, Pllc | |
|
6015 Fayetteville Rd Ste 113 Durham NC 27713-6254 | |
| (919) 794-4487 | |
| (833) 450-5132 |
| Full Name | Geode Health Of North Carolina, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6015 Fayetteville Rd Ste 113, Durham, North Carolina |
| Authorized Official Name and Position | Brandy Marriner (CREDENTIALING MANAGER) |
| Authorized Official Contact | 6309124241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geode Health Of North Carolina, Pllc 1211 W 22nd St Ste 406 Oak Brook IL 60523-2169 Ph: (888) 902-1704 | Geode Health Of North Carolina, Pllc 6015 Fayetteville Rd Ste 113 Durham NC 27713-6254 Ph: (919) 794-4487 |
| NPI Number | 1588433502 |
|---|---|
| Provider Enumeration Date | 01/02/2024 |
| Last Update Date | 08/08/2024 |
| Certification Date | 08/08/2024 |
| Medicare PECOS PAC ID | 2567801020 |
|---|---|
| Medicare Enrollment ID | O20240416003856 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588433502 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Stacia Crick Brommel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023216157 PECOS PAC ID: 6608037866 Enrollment ID: I20120416000054 |
| Provider Name | Ana Clara Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437316916 PECOS PAC ID: 9436379500 Enrollment ID: I20141013002530 |
| Provider Name | Mari-jane Shaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356718308 PECOS PAC ID: 6204123987 Enrollment ID: I20180110000564 |
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