Healthcare Provider Details

I. General information

NPI: 1417361775
Provider Name (Legal Business Name): CAROLINA HEALTHCARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 S 17TH ST
WILMINGTON NC
28401-7542
US

IV. Provider business mailing address

2221 S 17TH ST
WILMINGTON NC
28401-7542
US

V. Phone/Fax

Practice location:
  • Phone: 910-772-9202
  • Fax: 910-772-9452
Mailing address:
  • Phone: 910-772-9202
  • Fax: 910-772-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GOODWIN
Title or Position: DIRECTOR
Credential:
Phone: 910-772-9202