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General NPI Number Information
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NPI Number | 1104636034
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Entity Type | Organization
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Legal Business Name | CARETEAM PLUS, INC.
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 100 PROFESSIONAL PARK DR
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City | CONWAY
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State | SC
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Zip | 29526-9260
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Country | US
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Telephone | 843-234-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 100 PROFESSIONAL PARK DR
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City | CONWAY
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State | SC
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Zip | 29526-9260
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Country | US
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Telephone | 843-234-0005
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHANNA L HAYNES
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Credential | CEO
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Telephone | 843-234-8220
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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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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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