Provider Demographics
NPI:1851411912
Name:CAROLINA AGE REJUVENATION CLINIC
Entity Type:Organization
Organization Name:CAROLINA AGE REJUVENATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:REECE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:252-247-7298
Mailing Address - Street 1:208 PENNY LN # B
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4305
Mailing Address - Country:US
Mailing Address - Phone:252-247-7298
Mailing Address - Fax:
Practice Address - Street 1:208 PENNY LN # B
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4305
Practice Address - Country:US
Practice Address - Phone:252-247-7298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty