Provider Demographics
NPI:1497862155
Name:CABANISS, WILLIAM CARLTON JR (PA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARLTON
Last Name:CABANISS
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:7384 DAN RHYNE RD
Mailing Address - Street 2:
Mailing Address - City:VALE
Mailing Address - State:NC
Mailing Address - Zip Code:28168-9427
Mailing Address - Country:US
Mailing Address - Phone:843-817-7077
Mailing Address - Fax:
Practice Address - Street 1:1554 UNION RD STE C
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5581
Practice Address - Country:US
Practice Address - Phone:704-678-8876
Practice Address - Fax:704-772-0723
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-02367363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762491AMedicare PIN