Healthcare Provider Details

I. General information

NPI: 1386158616
Provider Name (Legal Business Name): CAROLINA ELITE WOMEN'S CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 US 70 HWY W STE 100
GARNER NC
27529-2664
US

IV. Provider business mailing address

901 US 70 HWY W STE 100
GARNER NC
27529-2664
US

V. Phone/Fax

Practice location:
  • Phone: 919-977-7095
  • Fax: 919-977-9289
Mailing address:
  • Phone: 919-977-7095
  • Fax: 919-977-9289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDOLPH SCOTT
Title or Position: OWNER
Credential: MD
Phone: 919-977-7095