Healthcare Provider Details

I. General information

NPI: 1659709046
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 AMENDMENT AVE
ROCK HILL SC
29732-3155
US

IV. Provider business mailing address

PO BOX 602478
CHARLOTTE NC
28260-2478
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-8990
  • Fax:
Mailing address:
  • Phone: 803-329-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LESLIE WIENS
Title or Position: SVP/OPERATIONS CPN
Credential:
Phone: 704-355-0648