Healthcare Provider Details

I. General information

NPI: 1689016610
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 OAK ST
CHERRYVILLE NC
28021-3423
US

IV. Provider business mailing address

PO BOX 601884
CHARLOTTE NC
28260-1884
US

V. Phone/Fax

Practice location:
  • Phone: 980-487-2200
  • Fax: 704-435-3295
Mailing address:
  • Phone: 980-487-2200
  • Fax: 704-435-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS FORD LAYMON
Title or Position: SVP
Credential:
Phone: 704-631-0002