Healthcare Provider Details

I. General information

NPI: 1447861968
Provider Name (Legal Business Name): CAROLINA COLON & RECTAL SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 SENNA DR
MATTHEWS NC
28105-6727
US

IV. Provider business mailing address

3049 SENNA DR
MATTHEWS NC
28105-6727
US

V. Phone/Fax

Practice location:
  • Phone: 980-339-5155
  • Fax: 980-216-8522
Mailing address:
  • Phone: 980-339-5155
  • Fax: 980-216-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN JERBY
Title or Position: SURGEON
Credential: MD
Phone: 980-339-5155