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General NPI Number Information
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NPI Number | 1881624955
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Entity Type | Organization
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Legal Business Name | CAROLINA PODIATRY ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 402 S MAIN ST
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City | RAEFORD
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State | NC
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Zip | 28376-3223
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Country | US
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Telephone | 910-904-0648
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Fax | 910-904-1810
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Provider Business Mailing Address
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Address Line | P O BOX 777
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City | RAEFORD
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State | NC
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Zip | 28376-2527
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Country | US
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Telephone | 910-904-0648
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Fax | 910-904-1810
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANITA B NETTLES
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Credential |
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Telephone | 910-904-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 24580
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License Number State | NC
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