Healthcare Provider Details

I. General information

NPI: 1699035378
Provider Name (Legal Business Name): CARSON LEWIS SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date: 06/11/2019
Reactivation Date: 06/14/2019

III. Provider practice location address

810 MITCHELL AVE
SALISBURY NC
28144-6253
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-216-5633
  • Fax: 704-639-0785
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number346771
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2022-00681
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: