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General NPI Number Information
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NPI Number | 1427483601
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Entity Type | Organization
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Legal Business Name | CAROLINA EXPRESS CLINIC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 5110 PARK RD 1J
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City | CHARLOTTE
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State | NC
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Zip | 28209
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Country | US
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Telephone | 704-496-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 5110 PARK RD 1J
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City | CHARLOTTE
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State | NC
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Zip | 28209
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Country | US
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Telephone | 704-572-0154
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MR. GREGORY S CHAMBERS
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Credential | PA-C
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Telephone | 704-572-0154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 001000254
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License Number State | NC
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