Organization
SOUTHEASTERN SPORTS MEDICINE PLLC
Active
Organization
SOUTHEASTERN SPORTS MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEREMY C CARRAWAY (IT MANAGER)
(828) 274-4555
Entity
Organization
Contact information
Practice address
23 TURTLE CREEK DR, ASHEVILLE, NC 28803-3152
(828) 274-4555
(828) 274-3615
Mailing address
23 TURTLE CREEK DRIVE, ASHEVILLE, NC 28803
(828) 274-4555
(828) 274-3615
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011FY
BCBS GROUP NUMBER
NC
05
—
89011FY
—
NC
Enumeration date
10/04/2006
Last updated
08/22/2020
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