Healthcare Provider Details

I. General information

NPI: 1881360899
Provider Name (Legal Business Name): CAROLINA QUICKCARE FAMILY PRACTICE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 NC HIGHWAY 24 27 E
BISCOE NC
27209-9758
US

IV. Provider business mailing address

2265 NC HIGHWAY 24 27 E
BISCOE NC
27209-9758
US

V. Phone/Fax

Practice location:
  • Phone: 919-810-0054
  • Fax:
Mailing address:
  • Phone: 919-828-1131
  • Fax: 910-876-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOGAN MCCALL
Title or Position: CEO
Credential:
Phone: 252-813-9104