Healthcare Provider Details

I. General information

NPI: 1811336571
Provider Name (Legal Business Name): CENTRAL CAROLINA PHYSICIANS - SANDHILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

PO BOX 742694
ATLANTA GA
30374-2694
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-6023
  • Fax: 919-776-6359
Mailing address:
  • Phone: 919-774-6023
  • Fax: 919-776-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009