Healthcare Provider Details

I. General information

NPI: 1407061146
Provider Name (Legal Business Name): CAROLINA FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 WEDDINGTON RD
MATTHEWS NC
28104-8318
US

IV. Provider business mailing address

1932 WEDDINGTON RD
MATTHEWS NC
28104-8318
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-4000
  • Fax:
Mailing address:
  • Phone: 704-847-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number201962
License Number StateNC

VIII. Authorized Official

Name: MRS. KRISTEN JEAN SPRATT
Title or Position: FNP
Credential: MSN
Phone: 704-847-4000