Provider Demographics
NPI:1689080962
Name:CAROLINA FOOT AND ANKLE HEALTH CENTER, PC
Entity type:Organization
Organization Name:CAROLINA FOOT AND ANKLE HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-603-0044
Mailing Address - Street 1:PO BOX 51363
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-1363
Mailing Address - Country:US
Mailing Address - Phone:919-603-0044
Mailing Address - Fax:919-603-0151
Practice Address - Street 1:103 PROFESSIONAL PARK
Practice Address - Street 2:SUITE B
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2581
Practice Address - Country:US
Practice Address - Phone:919-603-0044
Practice Address - Fax:919-603-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC562213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty