Healthcare Provider Details

I. General information

NPI: 1861438988
Provider Name (Legal Business Name): CAROLINA EAR, NOSE & THROAT HEAD AND NECK SURGERY CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HWY 16 SUITE 202
DENVER NC
28037
US

IV. Provider business mailing address

275 HWY 16 SUITE 202
DENVER NC
28037
US

V. Phone/Fax

Practice location:
  • Phone: 704-483-6635
  • Fax: 704-489-1101
Mailing address:
  • Phone: 704-483-6635
  • Fax: 704-489-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9601626
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLARD CARDWELL HARRILL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 828-322-2183