Healthcare Provider Details

I. General information

NPI: 1114190881
Provider Name (Legal Business Name): CAROMONT INTERNAL MEDICINE 2LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 REMOUNT RD STE D
GASTONIA NC
28054-7401
US

IV. Provider business mailing address

PO BOX 468329
ATLANTA GA
31146-8329
US

V. Phone/Fax

Practice location:
  • Phone: 404-943-0205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALICIA HOLDEN
Title or Position: LEAD
Credential: ACCOUNTING
Phone: 404-943-0205