Provider Demographics
NPI:1902031198
Name:BYNUM, ROSALIND TERRELLE (AASD)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:TERRELLE
Last Name:BYNUM
Suffix:
Gender:F
Credentials:AASD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 B EAST MAIN STREET
Mailing Address - Street 2:PO BOX 1710
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092
Mailing Address - Country:US
Mailing Address - Phone:704-735-5339
Mailing Address - Fax:704-735-5339
Practice Address - Street 1:114 B EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092
Practice Address - Country:US
Practice Address - Phone:704-735-5339
Practice Address - Fax:704-735-5339
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor