Healthcare Provider Details

I. General information

NPI: 1740499714
Provider Name (Legal Business Name): CAROLINA FAMILY MEDICINE & URGENT CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 E BROAD ST
STATESVILLE NC
28625-4301
US

IV. Provider business mailing address

1503 E BROAD ST
STATESVILLE NC
28625-4301
US

V. Phone/Fax

Practice location:
  • Phone: 704-871-9731
  • Fax: 704-871-1105
Mailing address:
  • Phone: 704-871-9731
  • Fax: 704-871-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number200001772371
License Number StateNC

VIII. Authorized Official

Name: MRS. CODEY JEAN BROWN
Title or Position: OFFICE MANAGER/DELEGATED OFFICIAL
Credential:
Phone: 704-871-9731