Organization
CAROLINA DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD EARL COOLEY M.D. (PRESIDENT/OWNER)
(704) 542-1366
Entity
Organization
Contact information
Practice address
10502 PARK RD, SUITE 100, CHARLOTTE, NC 28210-8479
(704) 542-1366
(704) 542-1063
Mailing address
10502 PARK RD, SUITE 100, CHARLOTTE, NC 28210-8479
(704) 542-1366
(704) 542-1063
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0212C
BCBS OF NC GROUP #
NC
Enumeration date
04/05/2006
Last updated
05/01/2008
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