1831530773 NPI number — CAROLINA ANTI AGING AND NEUROPATHY, PLLC

Table of content: (NPI 1831530773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831530773 NPI number — CAROLINA ANTI AGING AND NEUROPATHY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA ANTI AGING AND NEUROPATHY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1831530773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7476 WATERSIDE LOOP RD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28037-7679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-601-4968
Provider Business Mailing Address Fax Number:
704-822-5433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 E MARION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28152-6219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-284-6001
Provider Business Practice Location Address Fax Number:
704-471-9890
Provider Enumeration Date:
07/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-822-5433

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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