Provider Demographics
NPI:1578659694
Name:PUGH, CAROLYN KNOWLTON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:KNOWLTON
Last Name:PUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 N WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-1319
Mailing Address - Country:US
Mailing Address - Phone:252-717-7167
Mailing Address - Fax:
Practice Address - Street 1:707 W H SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3752
Practice Address - Country:US
Practice Address - Phone:252-758-6080
Practice Address - Fax:252-758-0009
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10448Medicare UPIN