Healthcare Provider Details

I. General information

NPI: 1417219163
Provider Name (Legal Business Name): CAROLINA HEALTHCARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 DOCTORS CIR BUILDING C
WILMINGTON NC
28401-7403
US

IV. Provider business mailing address

PO BOX 602484
CHARLOTTE NC
28260-2484
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-5182
  • Fax: 910-763-0291
Mailing address:
  • Phone: 910-763-5182
  • Fax: 910-763-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAN E GOODWIN
Title or Position: VP
Credential:
Phone: 910-667-7597