Provider Demographics
NPI:1205073491
Name:CAREY, ANTOINE JERMEL (PA)
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:JERMEL
Last Name:CAREY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5124
Practice Address - Country:US
Practice Address - Phone:704-283-8193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01655363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101960Medicaid
NC1205073491Medicaid
SC2381PAMedicaid
NC2762740Medicare PIN
NC2762740AMedicare PIN
NC2762740DMedicare PIN
NC8101960Medicaid
NC2762740LMedicare PIN
NC2762740BMedicare PIN
NC1205073491Medicaid
NC2762740IMedicare PIN
SC2381PAMedicaid
NC2762740CMedicare PIN
NC2762740HMedicare PIN
NC2762740KMedicare PIN
NC2762740EMedicare PIN