Provider Demographics
NPI:1134695026
Name:NORTH CAROLINA CENTER FOR WEIGHT MANAGEMENT
Entity Type:Organization
Organization Name:NORTH CAROLINA CENTER FOR WEIGHT MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNITA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PC-A
Authorized Official - Phone:919-842-5566
Mailing Address - Street 1:1370 NC 24-87 STE 174
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-8571
Mailing Address - Country:US
Mailing Address - Phone:919-842-5566
Mailing Address - Fax:919-375-2048
Practice Address - Street 1:181 MITTIE HADDOCK DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9379
Practice Address - Country:US
Practice Address - Phone:919-842-5566
Practice Address - Fax:919-375-2048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty