=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689080962
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA FOOT AND ANKLE HEALTH CENTER, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 02/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 PROFESSIONAL PARK SUITE B
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-2581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-603-0044
-----------------------------------------------------
Fax | 919-603-0151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51363
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27717-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-603-0044
-----------------------------------------------------
Fax | 919-603-0151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MILLICENT BROWN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 919-603-0044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 562
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------