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General NPI Number Information
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NPI Number | 1720245111
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Entity Type | Organization
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Legal Business Name | KERR LAKE ORTHOPAEDICS
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 120 CHARLES ROLLINS RD SUITE 205
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City | HENDERSON
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State | NC
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Zip | 27536-2882
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Country | US
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Telephone | 252-436-1314
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CHARLES ROLLINS ROAD SUITE 205
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City | HENDERSON
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State | NC
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Zip | 27536
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Country | US
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Telephone | 252-436-1314
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE CFO
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Name | JIM CHATMAN
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Credential |
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Telephone | 252-436-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 200800411
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License Number State | NC
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