Provider Demographics
NPI:1396766721
Name:CARLSON, WILLIAM N (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:N
Last Name:CARLSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9633 WALKER GLEN DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3548
Mailing Address - Country:US
Mailing Address - Phone:704-786-2637
Mailing Address - Fax:704-933-5954
Practice Address - Street 1:11711 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9418
Practice Address - Country:US
Practice Address - Phone:704-933-2266
Practice Address - Fax:704-933-5954
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC102138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913557Medicaid
NCS89723Medicare UPIN
NC8913557Medicaid