Healthcare Provider Details

I. General information

NPI: 1467402545
Provider Name (Legal Business Name): CAROLINA DIAGNOSTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 CAROLINA ST SUITE 200A
GREENSBORO NC
27401-6000
US

IV. Provider business mailing address

1313 CAROLINA ST SUITE 200A
GREENSBORO NC
27401-6000
US

V. Phone/Fax

Practice location:
  • Phone: 336-346-1973
  • Fax: 336-275-6381
Mailing address:
  • Phone: 336-346-1973
  • Fax: 336-275-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number113314
License Number StateNC

VIII. Authorized Official

Name: MS. REBECCA ANN BILLINGS-MIGNONE
Title or Position: ADMINISTRATOR
Credential: RPSGT
Phone: 336-346-1973