Healthcare Provider Details

I. General information

NPI: 1871690321
Provider Name (Legal Business Name): CAROLINA NEUROLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE BOONE TRL STE 1
RALEIGH NC
27607-7512
US

IV. Provider business mailing address

PO BOX 30068
RALEIGH NC
27622-0068
US

V. Phone/Fax

Practice location:
  • Phone: 919-789-8020
  • Fax: 919-789-8022
Mailing address:
  • Phone: 919-789-8020
  • Fax: 919-789-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MR. NICOLE SUTTON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 919-789-8020