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
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