Healthcare Provider Details

I. General information

NPI: 1215995444
Provider Name (Legal Business Name): CAROLINA ASTHMA AND ALLERGY CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 E 7TH ST SUITE 100
CHARLOTTE NC
28204-4319
US

IV. Provider business mailing address

PO BOX 63376
CHARLOTTE NC
28263-3376
US

V. Phone/Fax

Practice location:
  • Phone: 704-372-7900
  • Fax: 704-376-2216
Mailing address:
  • Phone: 704-372-7900
  • Fax: 704-376-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number00-18118
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN GRAY NORRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 704-372-7900