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General NPI Number Information
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NPI Number | 1699753160
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Entity Type | Individual
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Provider Name | CARROLL PAUL SHIVERS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 1000 BLYTHE BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5812
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Country | US
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Telephone | 704-355-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 927 EAST BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5203
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Country | US
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Telephone | 704-377-5772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101054441
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 28622
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 28622
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License Number State | NC
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