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General NPI Number Information
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NPI Number | 1518358498
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Entity Type | Organization
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Legal Business Name | CAROLINA AGE MANAGEMENT INSTITUTE, PC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 8712 LINDHOLM DR STE 302
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-1872
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Country | US
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Telephone | 704-997-6530
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Fax | 704-997-6529
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Provider Business Mailing Address
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Address Line | 8712 LINDHOLM DR STE 302
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-1872
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Country | US
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Telephone | 704-997-6530
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Fax | 704-997-6529
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. STEPHEN ROBERT GIORDANO
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Credential | D.O.
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Telephone | 704-997-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2007-01965
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License Number State | NC
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