Provider Demographics
NPI:1881927648
Name:CAROLINA SPORTS AND SPINE
Entity type:Organization
Organization Name:CAROLINA SPORTS AND SPINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:KANDANATT
Authorized Official - Last Name:ANTONY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-314-2788
Mailing Address - Street 1:3101 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2426
Mailing Address - Country:US
Mailing Address - Phone:252-442-4024
Mailing Address - Fax:252-442-5056
Practice Address - Street 1:3101 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2426
Practice Address - Country:US
Practice Address - Phone:252-442-4024
Practice Address - Fax:252-442-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-000052081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7328840001Medicare NSC