Provider Demographics
NPI:1730480559
Name:NORTH CAROLINA SHOULDER AND ELBOW SURGERY AND SPORTS MEDICINE, PA
Entity Type:Organization
Organization Name:NORTH CAROLINA SHOULDER AND ELBOW SURGERY AND SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:YEARGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:910-454-0010
Mailing Address - Street 1:6019 OLEANDER DR STE 200B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4813
Mailing Address - Country:US
Mailing Address - Phone:910-791-0313
Mailing Address - Fax:910-454-0011
Practice Address - Street 1:6019 OLEANDER DR STE 200B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4813
Practice Address - Country:US
Practice Address - Phone:910-791-0313
Practice Address - Fax:910-454-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty