NPI Registry Details

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NPI Number Detailed Information

     
Provider Information:    
  Name: Carroll Christopher Overton
  Gender: M
  Provider License Number If Given: 36124
     
NPI Information:    
  NPI: 1154361160
  Entity Type (Individual or Organization): 1-ind
  Enumeration Date: 6/7/2006
  Last Update Date: 7/8/2007
     
Provider Business Mailing Address:    
  Address: PO BOX 19368
Raleigh, NC 27619
  Phone Number: 9197878221
  Fax Number: 9197894461
     
Provider Business Practice Location Address:    
  Address: 3949 BROWNING PL
Raleigh, NC 27609
  Phone Number: 9197878221
  Fax Number: 9197894461
     
Provider Taxonomy:    
  Primary: 2085R0204X
  Secondary (if any):
  State: NC