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General NPI Number Information
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NPI Number | 1861896383
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Entity Type | Organization
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Legal Business Name | CAROLINAS PHYSICIANS NETWORK, INC.
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Dates
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Enumeration Date | 10/13/2014
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 320 YADKIN ST SUITE C
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City | ALBEMARLE
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State | NC
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Zip | 28001-3447
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Country | US
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Telephone | 704-983-0636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 601888
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City | CHARLOTTE
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State | NC
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Zip | 28260-1888
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Country | US
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Telephone | 704-986-6307
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Fax |
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Authorized Official
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Title or Position | SVP/OPERATIONS CPN
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Name | DANIEL LESLIE WIENS
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Credential |
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Telephone | 704-986-6307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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