Basic Information
| Provider Information | |||||||||
| NPI: | 1063404671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDBORN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DEAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1869 | ||||||||
| Address2: | |||||||||
| City: | FLETCHER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287321869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286876282 | ||||||||
| FaxNumber: | 8286876285 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HOSPITAL DR | ||||||||
| Address2: | SUITE 5 A | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286841115 | ||||||||
| FaxNumber: | 8286876064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 17518 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 74446 | 01 | NC | BCBS | OTHER | 8974446 | 05 | NC | MEDICAID |