Healthcare Provider Details

I. General information

NPI: 1336234095
Provider Name (Legal Business Name): SOUTHEASTERN SPORTS MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 TURTLE CREEK DR
ASHEVILLE NC
28803-3152
US

IV. Provider business mailing address

23 TURTLE CREEK DRIVE
ASHEVILLE NC
28803
US

V. Phone/Fax

Practice location:
  • Phone: 828-274-4555
  • Fax: 828-274-3615
Mailing address:
  • Phone: 828-274-4555
  • Fax: 828-274-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY C CARRAWAY
Title or Position: IT MANAGER
Credential:
Phone: 828-274-4555