Organization
CAROLINA PODIATRY ASSOCIATES, LLC
Active
Other names
CAROLINA PODIATRY & MEDICAL SPECIALTIES
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANITA B NETTLES (OFFICE MANAGER)
(910) 904-0648
Entity
Organization
Contact information
Practice address
402 S MAIN ST, RAEFORD, NC 28376-3223
(910) 904-0648
(910) 904-1810
Mailing address
P O BOX 777, RAEFORD, NC 28376-2527
(910) 904-0648
(910) 904-1810
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24580
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016TM
BLUECROSSBLUESHIELD NUMBE
NC
05
—
89016TM
—
NC
Enumeration date
07/04/2006
Last updated
08/22/2008
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