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General NPI Number Information
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NPI Number | 1245519032
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Entity Type | Organization
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Legal Business Name | CAROLINA HEALTHCARE ASSOCIATES INC
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 221 MEMORIAL DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6333
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Country | US
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Telephone | 910-455-5511
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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 | 704-631-0002
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DANIEL GOODWIN
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Credential |
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Telephone | 910-667-7597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology 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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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