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General NPI Number Information
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NPI Number | 1821179037
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Entity Type | Organization
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Legal Business Name | GREATER CAROLINA EAR NOSE &THROAT P.A.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4315 LUDGATE ST
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City | LUMBERTON
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State | NC
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Zip | 28358-2460
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Country | US
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Telephone | 910-738-1919
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Fax | 910-738-1991
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Provider Business Mailing Address
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Address Line | 4315 LUDGATE STREET
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City | LUMBERTON
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State | NC
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Zip | 28358-2460
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Country | US
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Telephone | 910-738-1919
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Fax | 910-738-1991
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Authorized Official
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Title or Position | OWNER
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Name | ANITA LOUISE JACKSON
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Credential | M.D., M.P.H
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Telephone | 910-738-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | NC
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