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General NPI Number Information
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NPI Number | 1659746576
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Entity Type | Organization
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Legal Business Name | CAROLINA MEDICORP ENTERPRISES INC
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 12/17/2015
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Provider Practice Location Address
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Address Line | 2620 N MAIN STREET SUITE 109
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City | HIGH POINT
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State | NC
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Zip | 27265-2735
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Country | US
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Telephone | 336-481-1970
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Fax | 336-884-5012
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Provider Business Mailing Address
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Address Line | PO BOX 751803
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City | CHARLOTTE
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State | NC
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Zip | 28275-1803
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Country | US
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Telephone | 336-481-1970
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Fax | 336-884-5012
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MR. GEOFFREY K GARDNER
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Credential |
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Telephone | 336-481-1970
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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 | NC
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