=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386713402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROLINA FAMILY PRACTICE CENTRE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 VILLAGE DR STE 100
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-3982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-485-1700
-----------------------------------------------------
Fax | 910-484-2800
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 VILLAGE DR STE 100
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28304-3982
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-476-6868
-----------------------------------------------------
Fax | 910-484-2800
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | FRANCES FRANCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-485-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 9701262
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------