Provider Demographics
NPI:1023777844
Name:CARR-GREEN, CAROLYN DENISE
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:DENISE
Last Name:CARR-GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 NEWKIRK RD
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-2636
Mailing Address - Country:US
Mailing Address - Phone:910-441-7022
Mailing Address - Fax:
Practice Address - Street 1:216 NEWKIRK RD
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-2636
Practice Address - Country:US
Practice Address - Phone:191-044-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6356253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care