Provider Demographics
NPI:1467633289
Name:CAROL LEE'S MEDICAL OFFICE
Entity Type:Organization
Organization Name:CAROL LEE'S MEDICAL OFFICE
Other - Org Name:CAROL LEE'S MEDICAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:910-422-9926
Mailing Address - Street 1:108 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28383-9602
Mailing Address - Country:US
Mailing Address - Phone:910-422-9926
Mailing Address - Fax:
Practice Address - Street 1:108 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-9602
Practice Address - Country:US
Practice Address - Phone:910-422-9926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200945364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335679Medicare PIN