Healthcare Provider Details

I. General information

NPI: 1902150832
Provider Name (Legal Business Name): INFINITE WELLNESS OF THE CAROLINAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 COMMERCE DR STE B
MONROE NC
28110-2839
US

IV. Provider business mailing address

103 COUNTRY CLUB DR NE
CONCORD NC
28025-2935
US

V. Phone/Fax

Practice location:
  • Phone: 704-282-9300
  • Fax:
Mailing address:
  • Phone: 704-792-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMARA H LOCKHART
Title or Position: BILLING
Credential: DC
Phone: 704-453-6335