Organization
CAROLINA DIGESTIVE DISEASES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAZETT SHIVERS (ADMINISTRATOR)
(252) 758-8181
Entity
Organization
Contact information
Practice address
704 WH SMITH BLVD, GREENVILLE, NC 27834
(252) 758-8181
(252) 758-8182
Mailing address
704 WH SMITH BLVD, GREENVILLE, NC 27834
(252) 758-8181
(252) 758-8182
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NC
174400000X
Specialist
—
—
207RG0100X
Gastroenterology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5906998
—
NC
Enumeration date
11/06/2006
Last updated
08/05/2020
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