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General NPI Number Information
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NPI Number | 1164770467
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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 | 08/17/2012
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 5955 WEDDINGTON RD
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City | WESLEY CHAPEL
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State | NC
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Zip | 28104-6296
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Country | US
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Telephone | 704-667-4280
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Fax | 704-667-4281
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Provider Business Mailing Address
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Address Line | PO BOX 601888
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City | CHARLOTTE
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State | NC
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Zip | 28260-1888
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Country | US
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Telephone | 704-667-4280
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Fax | 704-667-4281
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | DANIEL L WIENS
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Credential |
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Telephone | 704-355-0648
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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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