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General NPI Number Information
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NPI Number | 1831530773
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Entity Type | Organization
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Legal Business Name | CAROLINA ANTI AGING AND NEUROPATHY, PLLC
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 1920 E MARION ST
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City | SHELBY
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State | NC
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Zip | 28152-6219
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Country | US
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Telephone | 704-284-6001
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Fax | 704-471-9890
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Provider Business Mailing Address
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Address Line | 7476 WATERSIDE LOOP RD SUITE 600
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City | DENVER
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State | NC
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Zip | 28037-7679
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Country | US
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Telephone | 704-601-4968
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Fax | 704-822-5433
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEBRA D. POWELL
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Credential | PA-C
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Telephone | 704-822-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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