Provider Demographics
NPI:1407599830
Name:SOUTHERN KETAMINE CLINICS
Entity Type:Organization
Organization Name:SOUTHERN KETAMINE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:828-400-2400
Mailing Address - Street 1:2768 GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-7336
Mailing Address - Country:US
Mailing Address - Phone:828-407-6631
Mailing Address - Fax:828-417-3531
Practice Address - Street 1:2768 GEORGIA RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-7336
Practice Address - Country:US
Practice Address - Phone:828-407-6631
Practice Address - Fax:828-417-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy