Provider Demographics
NPI:1659233435
Name:ROOTS & RIDGE
Entity type:Organization
Organization Name:ROOTS & RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:HAMM-GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-520-8570
Mailing Address - Street 1:756 PARDUE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-8693
Mailing Address - Country:US
Mailing Address - Phone:336-520-8570
Mailing Address - Fax:
Practice Address - Street 1:756 PARDUE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-8693
Practice Address - Country:US
Practice Address - Phone:336-520-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty