# CAROLINA ANTI-AGING & WELLNESS CENTER PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013142488
- **Authorized official:** SUSAN WATSON DURHAM MD (PRESIDENT)
- **Authorized official phone:** (919) 774-0502

## Contact information

- **Practice address:** 1227 CARTHAGE ST, SANFORD, NC 27330-8984
- **Practice address phone:** (919) 774-0502
- **Practice address fax:** (919) 774-0505
- **Mailing address:** 1227 CARTHAGE ST, SANFORD, NC 27330-8984
- **Mailing address phone:** (919) 774-0502
- **Mailing address fax:** (919) 774-0505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 39413 | NC | Yes |
| 261QP3300X | Pain Clinic/Center | 39413 | NC | — |

## Other

- **Enumeration date:** 05/28/2009
- **Last updated:** 05/28/2009