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General NPI Number Information
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NPI Number | 1881927648
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Entity Type | Organization
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Legal Business Name | CAROLINA SPORTS AND SPINE
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3101 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2426
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Country | US
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Telephone | 252-442-4024
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Fax | 252-442-5056
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Provider Business Mailing Address
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Address Line | 3101 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2426
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Country | US
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Telephone | 252-442-4024
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Fax | 252-442-5056
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | DR. ALVIN KANDANATT ANTONY
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Credential | MD
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Telephone | 252-314-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2008-00005
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License Number State | NC
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