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General NPI Number Information
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NPI Number | 1407104466
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Entity Type | Organization
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Legal Business Name | CAROLINAS HEALTHCARE ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/24/2012
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Last Update Date | 01/10/2017
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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 | 910-353-9994
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Fax | 910-353-5784
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Provider Business Mailing Address
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Address Line | PO BOX 602484
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City | CHARLOTTE
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State | NC
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Zip | 28260-2484
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Country | US
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Telephone | 910-353-9994
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Fax | 910-353-5784
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Authorized Official
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Title or Position | VP
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Name | MR. DAN E 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 | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) 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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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