Organization
CAROLINA NEUROLOGICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEPARD AVERITT (ADMINISTRATOR)
(704) 377-9323
Entity
Organization
Contact information
Practice address
3541 RANDOLPH RD, SUITE 101, CHARLOTTE, NC 28211-1082
(704) 377-9323
(704) 331-4030
Mailing address
PO BOX 221009, CHARLOTTE, NC 28222-1009
(704) 377-9323
(704) 331-4030
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8901287
—
NC
Enumeration date
04/19/2006
Last updated
08/22/2020
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