Healthcare Provider Details

I. General information

NPI: 1063559193
Provider Name (Legal Business Name): CAROLINA SPECIALTY CARE,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SUNSET HILL DR
STATESVILLE NC
28625-2729
US

IV. Provider business mailing address

124 SUNSET HILL RD
STATESVILLE NC
28625
US

V. Phone/Fax

Practice location:
  • Phone: 704-872-8711
  • Fax: 704-872-5866
Mailing address:
  • Phone: 704-872-8711
  • Fax: 704-872-5866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number930036
License Number StateNC

VIII. Authorized Official

Name: MR. ROBERT I WODECKI
Title or Position: VICE -PRESIDENT
Credential: MD
Phone: 704-872-8711