Healthcare Provider Details

I. General information

NPI: 1982972501
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 OLD CAROLEEN ROAD
FOREST CITY NC
28043-3710
US

IV. Provider business mailing address

PO BOX 602148
CHARLOTTE NC
28260-2148
US

V. Phone/Fax

Practice location:
  • Phone: 828-245-4061
  • Fax: 828-245-4062
Mailing address:
  • Phone: 828-245-4061
  • Fax: 828-245-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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