Healthcare Provider Details

I. General information

NPI: 1629320916
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5641 POPLAR TENT RD SUITE 204
CONCORD NC
28027-7533
US

IV. Provider business mailing address

PO BOX 602699
CHARLOTTE NC
28260-2699
US

V. Phone/Fax

Practice location:
  • Phone: 704-510-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM FORD LAYMON
Title or Position: SVP
Credential:
Phone: 704-446-8250