Healthcare Provider Details

I. General information

NPI: 1295728426
Provider Name (Legal Business Name): CAROMONT OCCUPATIONAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 07/23/2007

III. Provider practice location address

2525 COURT DRIVE
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2525 COURT DRIVE
GASTONIA NC
28054-2140
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-3070
  • Fax: 704-834-3073
Mailing address:
  • Phone: 704-834-3070
  • Fax: 704-834-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLTON OWENSBY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 704-834-3070