Provider Demographics
NPI:1699526012
Name:TEW, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:TEW
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 1:3020-I PROSPERITY CHURCH RD
Mailing Address - Street 2:UNIT 118
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8100
Mailing Address - Country:US
Mailing Address - Phone:803-274-1893
Mailing Address - Fax:
Practice Address - Street 1:245 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4919
Practice Address - Country:US
Practice Address - Phone:803-274-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant