Provider Demographics
NPI:1225152911
Name:MCLAMB, CARRA AVERY (PAC)
Entity Type:Individual
Prefix:MRS
First Name:CARRA
Middle Name:AVERY
Last Name:MCLAMB
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DENIM DR
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339-2307
Mailing Address - Country:US
Mailing Address - Phone:910-897-5521
Mailing Address - Fax:910-897-2003
Practice Address - Street 1:901 DENIM DR
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-2307
Practice Address - Country:US
Practice Address - Phone:910-897-5521
Practice Address - Fax:910-897-2003
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC1862AMedicare PIN