Healthcare Provider Details

I. General information

NPI: 1780634907
Provider Name (Legal Business Name): CAROLINA MOUNTAIN GASTROENTEROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 FLEMING ST
HENDERSONVILLE NC
28791-3532
US

IV. Provider business mailing address

1032 FLEMING ST
HENDERSONVILLE NC
28791-3532
US

V. Phone/Fax

Practice location:
  • Phone: 828-696-3099
  • Fax: 828-696-3868
Mailing address:
  • Phone: 828-696-3099
  • Fax: 828-696-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARL PETER STAMM
Title or Position: MD
Credential: MD
Phone: 828-696-3099