Provider Demographics
NPI:1831159391
Name:CARPENTER, SALLY LAWSON (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:LAWSON
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-0570
Mailing Address - Country:US
Mailing Address - Phone:919-300-1440
Mailing Address - Fax:919-934-9703
Practice Address - Street 1:11 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4748
Practice Address - Country:US
Practice Address - Phone:919-934-0564
Practice Address - Fax:919-934-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC29813208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014WJMedicaid