Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 2012-00810 | NC |
N | 208000000X | Pediatrician | TL30225 | SC |
NPI | 1043367915 |
---|---|
Provider Name | Cody Garrett Carpenter |
First Address | Charlotte, NC 28211-0035 |
Second Address | Charlotte, NC 28211-0035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 28/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171J0 | BCBS (01) | NC |
302256 | (05) | SC |
59-21309 | (05) | NC |
NC6547A | (02) | NC |