Provider Demographics
NPI:1871690321
Name:CAROLINA NEUROLOGY CONSULTANTS
Entity Type:Organization
Organization Name:CAROLINA NEUROLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-789-8020
Mailing Address - Street 1:PO BOX 30068
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27622-0068
Mailing Address - Country:US
Mailing Address - Phone:919-789-8020
Mailing Address - Fax:919-789-8022
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:STE 1
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-789-8020
Practice Address - Fax:919-789-8022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2337445Medicare ID - Type Unspecified