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Organization
SHOCKWAVE SPECIALISTS OF THE CAROLINAS LLC
Active
Organization
SHOCKWAVE SPECIALISTS OF THE CAROLINAS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. M FILMORE HODNETT MBA CPA (BUSINESS MANAGER)
(704) 897-2031
Entity
Organization
Contact information
Practice address
705 GRIFFITH ST, STE 205, DAVIDSON, NC 28036
(704) 897-1024
(704) 897-2033
Mailing address
PO BOX 30428, CHARLOTTE, NC 28230
(704) 897-1024
(704) 897-2033
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00000
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014GA
BCBS
NC
Enumeration date
07/10/2006
Last updated
08/22/2020
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