MEDICARE: CAROLINAS PHYSICIANS NETWORK 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	207QS0010X	Sports Medicine (Family Medicine) Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1912262593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS PHYSICIANS NETWORK INC

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:	704-631-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 S US 29 HWY
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-8650
Country	:	US
Telephone Number	:	704-403-6800
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	THOMAS LAYMON
Credential	:
Telephone Number	:	704-446-8250

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	05/06/2021

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