NPIMap

Organization Active NPI

Carolina Neurological Clinic, PA

  • Neurology Physician
  • Charlotte, NC
National Provider Identifier
1902861396
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
CAROLINA NEUROLOGICAL CLINIC, PA
Practice address
3541 Randolph Rd
Suite 101
Charlotte, NC 28211-1082
Phone
(704) 377-9323
Fax
(704) 331-4030
NPI assigned
Apr 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shepard Averitt
Title
Administrator
Phone
(704) 377-9323

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

3541 Randolph Rd
Suite 101
Charlotte, NC 28211-1082

Mailing address

PO Box 221009
Charlotte, NC 28222-1009
Phone (704) 377-9323

Other identifiers 1

IdentifierTypeStateIssuer
8901287MedicaidNC

National Provider Directory

National Provider Directory

Locations

10620 Park Rd
Ste 128B
Charlotte, NC 28210
Phone (704) 541-8788

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902861396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221009",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282221009",
            "telephone_number": "704-377-9323",
            "fax_number": "704-331-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 RANDOLPH RD",
            "address_2": "SUITE 101",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111082",
            "telephone_number": "704-377-9323",
            "fax_number": "704-331-4030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA NEUROLOGICAL CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AVERITT",
        "authorized_official_first_name": "SHEPARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-377-9323"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8901287",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.