Provider Demographics
NPI:1578222600
Name:CAROLINA STEM CELL INSTITUTE LLC
Entity Type:Organization
Organization Name:CAROLINA STEM CELL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:704-200-9761
Mailing Address - Street 1:1720 ABBEY PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3736
Mailing Address - Country:US
Mailing Address - Phone:704-200-9761
Mailing Address - Fax:
Practice Address - Street 1:1720 ABBEY PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3736
Practice Address - Country:US
Practice Address - Phone:704-200-9761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty