Healthcare Provider Details

I. General information

NPI: 1417940990
Provider Name (Legal Business Name): PAUL P. CARNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SUNDAY DR
RALEIGH NC
27607-5253
US

IV. Provider business mailing address

1540 SUNDAY DR
RALEIGH NC
27607-6010
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-3456
  • Fax: 919-783-1441
Mailing address:
  • Phone: 919-782-3456
  • Fax: 919-783-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD420312L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2014-01917
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2014-01917
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: