Organization
CENTRAL CAROLINA DERMATOLOGY CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE N KEARNS (PRACTICE ADMINISTRATOR)
(336) 934-5070
Entity
Organization
Contact information
Practice address
4010 MENDENHALL OAKS PKWY, HIGH POINT, NC 27265-8076
(336) 887-3195
(336) 887-3194
Mailing address
4010 MENDENHALL OAKS PKWY, HIGH POINT, NC 27265-8076
(336) 887-3195
(336) 887-3194
Taxonomy
Speciality
Code
Description
License number
State
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
34D0238143
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230129
MEDICARE GROUP NUMBER
NC
05
—
8901788
—
NC
01
—
CD4358
RAILROAD MEDICARE
NC
Enumeration date
06/27/2005
Last updated
03/24/2021
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