Provider Demographics
NPI:1790976991
Name:PERRY, CARSON DAVID (CO)
Entity Type:Individual
Prefix:MR
First Name:CARSON
Middle Name:DAVID
Last Name:PERRY
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 AVIEMORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9797
Mailing Address - Country:US
Mailing Address - Phone:910-295-4489
Mailing Address - Fax:910-215-8035
Practice Address - Street 1:95 AVIEMORE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9797
Practice Address - Country:US
Practice Address - Phone:910-295-4489
Practice Address - Fax:910-215-8035
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335E00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist