Basic Information
Provider Information
NPI: 1508382961
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BABBITT
FirstName: SARA
MiddleName: FITZHENRY
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: FITZHENRY
OtherFirstName: SARA
OtherMiddleName: ASHLEY
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PA-C
OtherLastNameType: 1
Mailing Information
Address1: 210 TOWNE VILLAGE DR
Address2:  
City: CARY
State: NC
PostalCode: 275138910
CountryCode: US
TelephoneNumber: 9198593373
FaxNumber: 9193364363
Practice Location
Address1: 3000 NEW BERN AVE
Address2:  
City: RALEIGH
State: NC
PostalCode: 276101231
CountryCode: US
TelephoneNumber: 9193508000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2017
LastUpdateDate: 02/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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