Healthcare Provider Details

I. General information

NPI: 1134334295
Provider Name (Legal Business Name): ORTHOCAROLINA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WT HARRIS BLVD SUITE 1110
CHARLOTTE NC
28262-3485
US

IV. Provider business mailing address

PO BOX 403572
ATLANTA GA
30384-3572
US

V. Phone/Fax

Practice location:
  • Phone: 704-339-1073
  • Fax: 704-323-3911
Mailing address:
  • Phone: 704-323-2000
  • Fax: 704-323-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS F LAYMON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 704-323-2000