Healthcare Provider Details

I. General information

NPI: 1124820568
Provider Name (Legal Business Name): MARK ANDREW SCALES JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

1609 ZION CHURCH RD
SANFORD NC
27330-9492
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8712
  • Fax:
Mailing address:
  • Phone: 919-413-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0010-15798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: