Healthcare Provider Details

I. General information

NPI: 1437528916
Provider Name (Legal Business Name): CAROLINA NEUROSURGERY & SPINE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LAKE CONCORD RD NE
CONCORD NC
28025-2918
US

IV. Provider business mailing address

225 BALDWIN AVE
CHARLOTTE NC
28204-3109
US

V. Phone/Fax

Practice location:
  • Phone: 704-792-2672
  • Fax: 704-792-2674
Mailing address:
  • Phone: 704-376-1605
  • Fax: 704-335-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. EMMET HUNTER DYER
Title or Position: PRESENT
Credential: MD
Phone: 704-376-1605