Healthcare Provider Details

I. General information

NPI: 1679628580
Provider Name (Legal Business Name): NORTH CAROLINA ANESTHESIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MORVEN RD
WADESBORO NC
28170-2745
US

IV. Provider business mailing address

2910 SELWYN AVE # 157
CHARLOTTE NC
28209-1762
US

V. Phone/Fax

Practice location:
  • Phone: 843-651-2624
  • Fax: 843-357-4940
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL T MITCHELL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 843-651-2624