Healthcare Provider Details

I. General information

NPI: 1932936226
Provider Name (Legal Business Name): CAROLINA PAIN AND WEIGHT LOSS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 JAKE ALEXANDER BLVD W
SALISBURY NC
28147-1365
US

IV. Provider business mailing address

131 WELTON WAY
MOORESVILLE NC
28117-9163
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-4564
  • Fax:
Mailing address:
  • Phone: 704-360-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN B DAVIS
Title or Position: OWNER/PROVIDER
Credential: FNP-BC
Phone: 704-360-4564