Healthcare Provider Details

I. General information

NPI: 1669792503
Provider Name (Legal Business Name): CAROLINAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BILLINGSLEY ROAD BEHAVIORAL HEALTH CENTER CMC RANDOLPH
CHARLOTTE NC
28211-1009
US

IV. Provider business mailing address

501 BILLINGSLEY ROAD BEHAVIORAL HEALTH CENTER CMC RANDOLPH
CHARLOTTE NC
28211-1009
US

V. Phone/Fax

Practice location:
  • Phone: 704-358-2724
  • Fax: 704-358-2796
Mailing address:
  • Phone: 704-358-2724
  • Fax: 704-358-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberH0071
License Number StateNC

VIII. Authorized Official

Name: THOMAS E. GETTELMAN
Title or Position: ASSISTANT VICE PRESIDENT
Credential: PHD
Phone: 704-444-2406