Healthcare Provider Details

I. General information

NPI: 1841674264
Provider Name (Legal Business Name): CAROLINA HEALTHCARE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 05/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SHIPYARD BLVD
WILMINGTON NC
28403-8052
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-9833
  • Fax:
Mailing address:
  • Phone: 704-631-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL GOODWIN
Title or Position: VICE-PRESIDENT
Credential:
Phone: 910-667-7597