Healthcare Provider Details

I. General information

NPI: 1194723882
Provider Name (Legal Business Name): RICHARD S. CARLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 05/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL DR NE
BOLIVIA NC
28422-8346
US

IV. Provider business mailing address

924 N HOWE ST
SOUTHPORT NC
28461-3038
US

V. Phone/Fax

Practice location:
  • Phone: 843-497-5929
  • Fax: 843-497-6601
Mailing address:
  • Phone: 910-457-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9900789
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: