Healthcare Provider Details

I. General information

NPI: 1700794286
Provider Name (Legal Business Name): CARLY CRAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E GATE CITY BLVD
GREENSBORO NC
27406-1457
US

IV. Provider business mailing address

1112 TONTI WAY APT 5104
DURHAM NC
27703-7077
US

V. Phone/Fax

Practice location:
  • Phone: 336-375-9232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number20835
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: