MEDICARE: CAROMONT MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1093063398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROMONT MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 744786
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4786
Country	:	US
Telephone Number	:	704-834-2450
Fax Number	:	704-671-5331

Provider Business Practice Location Address
First Line	:	2391 COURT DR STE 105
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2197
Country	:	US
Telephone Number	:	704-671-7390
Fax Number	:	704-671-7396

Authorized Official
Title or Position	:	CFO
Name	:	DAVID MICHAEL OCONNOR
Credential	:
Telephone Number	:	704-671-5343

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	02/28/2023

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Directions to “CAROMONT MEDICAL GROUP, INC. ” Practice Location

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