Healthcare Provider Details

I. General information

NPI: 1912299413
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 GOLD HILL RD SUITE 203
FORT MILL SC
29715-8906
US

IV. Provider business mailing address

PO BOX 602148
CHARLOTTE NC
28260-2148
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-3510
  • Fax: 704-540-3668
Mailing address:
  • Phone: 704-381-3510
  • Fax: 704-540-3668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS FORD LAYMON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 704-631-0002