Healthcare Provider Details

I. General information

NPI: 1679998348
Provider Name (Legal Business Name): CAROLINA CLINIC FOR HEALTH AND WELLNESS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 EMERALD PL STE 102
GREENVILLE NC
27834-5784
US

IV. Provider business mailing address

2414 EMERALD PL
GREENVILLE NC
27834-5784
US

V. Phone/Fax

Practice location:
  • Phone: 252-757-3939
  • Fax:
Mailing address:
  • Phone: 252-757-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GWENDOLYN KNUCKLES
Title or Position: OWNER
Credential:
Phone: 252-830-1035