Healthcare Provider Details

I. General information

NPI: 1104093111
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8560 COOK ST
MT PLEASANT NC
28124-7686
US

IV. Provider business mailing address

PO BOX 71061
CHARLOTTE NC
28272-1061
US

V. Phone/Fax

Practice location:
  • Phone: 704-436-6521
  • Fax: 704-436-9505
Mailing address:
  • Phone: 704-436-6521
  • Fax: 704-436-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LYNN HAWKINS
Title or Position: AVP
Credential:
Phone: 704-721-2062