Healthcare Provider Details

I. General information

NPI: 1750870127
Provider Name (Legal Business Name): CAROL BASHIR BOUNAJIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MASON FARM RD
CHAPEL HILL NC
27599-6134
US

IV. Provider business mailing address

102 MASON FARM RD
CHAPEL HILL NC
27599-6134
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1459
  • Fax: 919-843-2356
Mailing address:
  • Phone: 919-966-1459
  • Fax: 919-843-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number238912
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021-01945
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: