Provider Demographics
NPI:1043970312
Name:SURRATT, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:SURRATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6742
Mailing Address - Country:US
Mailing Address - Phone:803-849-2925
Mailing Address - Fax:
Practice Address - Street 1:122 E DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6742
Practice Address - Country:US
Practice Address - Phone:803-849-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No347E00000XTransportation ServicesTransportation Broker