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	213E00000X	Podiatrist
2	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02G2B	OTHER	NC	BCBS OF NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457913006
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 100
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2197
Country	:	US
Telephone Number	:	980-834-7300
Fax Number	:	980-834-9874

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

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	08/25/2022

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Directions to “CAROMONT MEDICAL GROUP INC ” Practice Location

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