Healthcare Provider Details

I. General information

NPI: 1700600814
Provider Name (Legal Business Name): CENTRAL CAROLINA NEPHROLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330
US

IV. Provider business mailing address

1135 CARTHAGE ST
SANFORD NC
27330
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-7232
  • Fax: 919-775-0422
Mailing address:
  • Phone: 919-775-7232
  • Fax: 919-775-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA PORTFELT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-775-7232