Healthcare Provider Details

I. General information

NPI: 1013030543
Provider Name (Legal Business Name): CAROLINA EAST MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAROLINA AVE
WASHINGTON NC
27889-3571
US

IV. Provider business mailing address

1201 CAROLINA AVE
WASHINGTON NC
27889-3571
US

V. Phone/Fax

Practice location:
  • Phone: 252-975-1111
  • Fax: 252-975-6696
Mailing address:
  • Phone: 252-975-1111
  • Fax: 252-975-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNEY FRANKLIN BLOUNT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 252-975-1111