Individual
MRS. CAROLINE BROOKE JUSTUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3030 RANDOLPH RD, SUITE 200, MMG MUSEUM, CHARLOTTE, NC 28211-1368
(704) 302-8200
(704) 302-8201
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-8200
(704) 302-8201
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103732
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0189PA
—
SC
05
—
1861505828
—
NC
05
—
8101156
—
NC
Enumeration date
08/16/2006
Last updated
10/24/2014
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