Healthcare Provider Details

I. General information

NPI: 1215049242
Provider Name (Legal Business Name): KIP ALAN CORRINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7607 NC HIGHWAY 68 N STE B
OAK RIDGE NC
27310-8803
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-643-3378
  • Fax: 336-643-3670
Mailing address:
  • Phone: 336-643-3378
  • Fax: 336-643-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200000755
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: