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General NPI Number Information
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NPI Number | 1700600814
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Entity Type | Organization
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Legal Business Name | CENTRAL CAROLINA NEPHROLOGY SERVICES
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1135 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330
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Country | US
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Telephone | 919-775-7232
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Fax | 919-775-0422
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Provider Business Mailing Address
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Address Line | 1135 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330
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Country | US
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Telephone | 919-775-7232
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Fax | 919-775-0422
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MELISSA PORTFELT
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Credential |
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Telephone | 919-775-7232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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