| Organization Name: | CAROLINA ANTI-AGING & WELLNESS CENTER PA |
| NPI Number: | 1013142488 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN WATSON DURHAM (PRESIDENT) |
| Mailing Address: | 1227 Carthage St Sanford |
| State: | NC US |
| Postal Code: | 273308984 |
| Phone Number: | 9197740502 |
| Fax Number: | 9197740505 |
| NPI Enumeration Date: | 05/28/2009 |
| NPI Last Update Date: | 05/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | 39413 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |