Healthcare Provider Details

I. General information

NPI: 1275858698
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GRIFFITH STREET SUITE 100
DAVIDSON NC
28036-9305
US

IV. Provider business mailing address

PO BOX 601067
CHARLOTTE NC
28260-1067
US

V. Phone/Fax

Practice location:
  • Phone: 704-373-1813
  • Fax: 704-342-5871
Mailing address:
  • Phone: 704-373-1813
  • Fax: 704-342-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5950662
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

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