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General NPI Number Information
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NPI Number | 1093419285
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Entity Type | Organization
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Legal Business Name | CAROLINAS PHYSICIANS NETWORK INC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 10620 PARK RD STE 202
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City | CHARLOTTE
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State | NC
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Zip | 28210-0106
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Country | US
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Telephone | 704-468-0089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19305
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City | CHARLOTTE
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State | NC
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Zip | 28219-9305
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Country | US
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Telephone | 704-468-0089
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT RISSMILLER
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Credential | MD
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Telephone | 704-631-0002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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