Healthcare Provider Details

I. General information

NPI: 1457312639
Provider Name (Legal Business Name): BRENTON S CURRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 S RIDGECREST AVE
RUTHERFORDTON NC
28139-2838
US

IV. Provider business mailing address

PO BOX 75358
CHARLOTTE NC
28275-0358
US

V. Phone/Fax

Practice location:
  • Phone: 843-237-3378
  • Fax: 843-237-5073
Mailing address:
  • Phone: 843-237-3378
  • Fax: 843-237-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000103058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: