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AZALEA SKIN TREATMENT CENTER PA
NPI 1760512032
Specialist in Garner, NC

Active since March 06, 2007CLIA 34D0724226 · Certificate of Compliance
958 VANDORA SPRINGS RD, GARNER, NC 27529(919) 772-3487(919) 772-3446 Get Directions Write a Review

NPPES record last updated: April 26, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Azalea Skin Treatment Center Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AZALEA SKIN TREATMENT CENTER PA (NPI 1760512032) is a healthcare organization registered as a specialist in Garner, North Carolina and active in the NPI registry since March 2007. The organization holds a CLIA Certificate of Compliance certificate valid through August 20, 2027 and lists William Stewart Ketcham, President, as its authorized official.

NPPES Registry Identity

NPI1760512032
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameAZALEA SKIN TREATMENT CENTER PA
Location Address958 VANDORA SPRINGS RDGarner, NC 27529-3544
Mailing AddressPo Box 60634Charlotte, NC 28260-0634 · (919) 772-3487 · Fax (919) 772-3446
Phone(919) 772-3487
Fax(919) 772-3446
Organization SubpartNo
Authorized OfficialWilliam Stewart KetchamPresident · (919) 773-4959
Enumeration DateMarch 6, 2007
Last NPPES UpdateApril 26, 2012
✔ NPI 1760512032 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in NC · 29605
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

958 VANDORA SPRINGS RD, Garner, NC 27529
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Other Identifiers 3

Other0273LNC · Bcbs Of Nc Group Number
Other070014474NC · Railroad Medicare
Medicare PIN2338206NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 34D0724226

Azalea Skin Treatment Center · Garner, NC
Active · expires Aug 20, 2027
CLIA Number34D0724226
Laboratory TypePhysician Office
Certificate Effective DateAugust 21, 2025
Certificate Expiration DateAugust 20, 2027
Laboratory DirectorJonathan M. Olson
Laboratory Phone(919) 772-3487
Laboratory LocationAzalea Skin Treatment Center501 Health Park Drive, Suite 150, Garner, NC 27529
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. CRYSTAL RITCHIE THORNTON NP-C
Nurse Practitioner (Family)
958 VANDORA SPRINGS RD
GARNER, NC 27529
Wake County (919) 772-3587
MS. CATHY MARIE POOLE FNP
Nurse Practitioner (Family)
958 VANDORA SPRINGS RD
GARNER, NC 27529
Wake County (919) 772-3487
ESTHER M.H. NAKAGAWARA O.D.
Optometrist
958 VANDORA SPRINGS RD
GARNER, NC 27529
Wake County (919) 346-6945

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Azalea Skin Treatment Center PA's NPI number?

The NPI number for Azalea Skin Treatment Center PA is 1760512032. It was assigned to this organization in the NPPES registry on March 6, 2007.

Where is Azalea Skin Treatment Center PA located?

Azalea Skin Treatment Center PA is located at 958 Vandora Springs Rd, Garner, NC 27529. The listed phone number is (919) 772-3487.

What is Azalea Skin Treatment Center PA's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Azalea Skin Treatment Center PA hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 34D0724226) is associated with this NPI, valid through August 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Azalea Skin Treatment Center PA was last updated on April 26, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.