Provider Demographics
NPI:1386024123
Name:CAROTHERS, AMELIA MATHIS
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:MATHIS
Last Name:CAROTHERS
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 1:4117 BRYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9706
Mailing Address - Country:US
Mailing Address - Phone:336-580-2420
Mailing Address - Fax:
Practice Address - Street 1:511 WINDMILL ST
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-7706
Practice Address - Country:US
Practice Address - Phone:336-591-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program