Healthcare Provider Details

I. General information

NPI: 1699870584
Provider Name (Legal Business Name): CAROLINA RADIOLOGY CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 SO TARBORO ST WILSON MEDICAL CENTER
WILSON NC
27893
US

IV. Provider business mailing address

PO BOX 63307
CHARLOTTE NC
28263-3307
US

V. Phone/Fax

Practice location:
  • Phone: 252-399-8928
  • Fax: 252-399-7313
Mailing address:
  • Phone: 866-759-4524
  • Fax: 757-512-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: JEFFREY EMERSON JONES
Title or Position: PRESIDENT
Credential: MD
Phone: 252-399-8695