Healthcare Provider Details

I. General information

NPI: 1033243563
Provider Name (Legal Business Name): CAROLINA ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W HENDERSON ST
SALISBURY NC
28144-2725
US

IV. Provider business mailing address

825 W HENDERSON ST
SALISBURY NC
28144-2725
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-5542
  • Fax: 704-636-5142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number19313
License Number StateNC

VIII. Authorized Official

Name: WILLIAM BRINKLEY
Title or Position: OWNER
Credential: MD
Phone: 704-636-5542