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General NPI Number Information
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NPI Number | 1124052444
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Entity Type | Organization
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Legal Business Name | CAROLINA DIGESTIVE HEALTH ASSOCIATES, PA
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 300 BILLINGSLEY RD STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28211-1180
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Country | US
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Telephone | 704-372-7974
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Fax | 704-372-8201
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Provider Business Mailing Address
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Address Line | PO BOX 96314
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City | CHARLOTTE
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State | NC
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Zip | 28296-0314
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Country | US
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Telephone | 704-372-7974
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Fax | 704-372-8201
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | JULIE ROTHROCK
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Credential |
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Telephone | 704-372-7974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 40474
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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