Provider Demographics
NPI:1679998348
Name:CAROLINA CLINIC FOR HEALTH AND WELLNESS PA
Entity Type:Organization
Organization Name:CAROLINA CLINIC FOR HEALTH AND WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-757-3939
Mailing Address - Street 1:2459 EMERALD PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5732
Mailing Address - Country:US
Mailing Address - Phone:252-757-3939
Mailing Address - Fax:
Practice Address - Street 1:2459 EMERALD PL
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5732
Practice Address - Country:US
Practice Address - Phone:252-757-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty