Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 24581 | NC |
NPI | 1255323044 |
---|---|
Provider Name | Samuel J Chewning JR. |
First Address | Charlotte, NC 28204-3109 |
Second Address | Charlotte, NC 28204-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8922291 | (05) | NC |
C83208 | (02) | NC |