Healthcare Provider Details

I. General information

NPI: 1730198185
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6030 W HIGHWAY 74 SUITE F
INDIAN TRAIL NC
28079-3468
US

IV. Provider business mailing address

PO BOX 60026
CHARLOTTE NC
28260-0026
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-2900
  • Fax: 704-246-2899
Mailing address:
  • Phone: 704-246-2900
  • Fax: 704-246-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L WIENS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 704-355-0648