Healthcare Provider Details

I. General information

NPI: 1972797520
Provider Name (Legal Business Name): CAROLINA ORTHOPEDIC AND SPORTS MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 BRIDGES ST SUITE 202
MOREHEAD CITY NC
28557-2944
US

IV. Provider business mailing address

738 NEWMAN RD
NEW BERN NC
28562-5238
US

V. Phone/Fax

Practice location:
  • Phone: 252-634-2676
  • Fax: 252-633-3502
Mailing address:
  • Phone: 252-634-2676
  • Fax: 252-633-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number142144
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number142144
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number142144
License Number StateNC

VIII. Authorized Official

Name: DAWN D GARRETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 252-634-2676