Healthcare Provider Details

I. General information

NPI: 1659512531
Provider Name (Legal Business Name): CAROLINA FOOT AND MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRCH ST
RAEFORD NC
28376-3297
US

IV. Provider business mailing address

300 BIRCH ST
RAEFORD NC
28376-3297
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-6600
  • Fax: 910-904-1810
Mailing address:
  • Phone: 910-904-6600
  • Fax: 910-904-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITA NETTLES
Title or Position: OFFICE MANAGER
Credential:
Phone: 910-904-6600