Healthcare Provider Details

I. General information

NPI: 1699004697
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 S TRYON ST
CHARLOTTE NC
28273-3108
US

IV. Provider business mailing address

PO BOX 60143
CHARLOTTE NC
28260-0143
US

V. Phone/Fax

Practice location:
  • Phone: 803-328-6281
  • Fax: 803-981-5136
Mailing address:
  • Phone: 803-328-6281
  • Fax: 803-981-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L. WIENS
Title or Position: SENIOR VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 704-355-0648