Healthcare Provider Details

I. General information

NPI: 1497996672
Provider Name (Legal Business Name): CAROLINA ANESTHESIA GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ROCKFORD ST
MOUNT AIRY NC
27030-5322
US

IV. Provider business mailing address

PO BOX 2297
ASHEVILLE NC
28802-2297
US

V. Phone/Fax

Practice location:
  • Phone: 336-719-7000
  • Fax: 828-398-5223
Mailing address:
  • Phone: 828-210-9386
  • Fax: 828-210-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH RAYNOR ELLINGTON
Title or Position: PRESIDENT
Credential: MD
Phone: 864-576-2073