Healthcare Provider Details

I. General information

NPI: 1538270731
Provider Name (Legal Business Name): CAROLINA SPINE & HAND CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 BRENNER AVE SUITE 102
SALISBURY NC
28144
US

IV. Provider business mailing address

1809 BRENNER AVE SUITE 102
SALISBURY NC
28144
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-4646
  • Fax: 704-636-4447
Mailing address:
  • Phone: 704-636-4646
  • Fax: 704-636-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103906
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number101229
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number9900416
License Number StateNC

VIII. Authorized Official

Name: MR. JEFFREY ALAN BAKER
Title or Position: OWNER
Credential: MD
Phone: 704-636-4646