Organization
COMMUNITY INNOVATIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY ANDERSON (PRESIDENT)
(910) 642-5697
Entity
Organization
Contact information
Practice address
410 PEANUT PLANT ROAD, ELIZABETHTOWN, NC 28337
(910) 862-8363
Mailing address
801 WILSON ST, WHITEVILLE, NC 28472-4713
(919) 642-5697
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906101
—
NC
Enumeration date
05/25/2007
Last updated
11/29/2007
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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