Healthcare Provider Details

I. General information

NPI: 1578439857
Provider Name (Legal Business Name): CAROLINAS FERTILITY INSTITUTE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HAWTHORNE PARK CT
GREENVILLE SC
29615-3194
US

IV. Provider business mailing address

PO BOX 25804
WINSTON SALEM NC
27114-5804
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-9100
  • Fax:
Mailing address:
  • Phone: 336-448-9100
  • Fax: 336-448-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PENNY RODRIGUEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 336-448-9100