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General NPI Number Information
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NPI Number | 1962042416
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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 | 01/13/2020
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 2709 WATER RIDGE PKWY STE 500
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City | CHARLOTTE
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State | NC
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Zip | 28217-4596
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Country | US
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Telephone | 855-438-0010
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19305
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City | CHARLOTTE
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State | NC
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Zip | 28219-9305
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Country | US
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Telephone | 704-631-0002
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Fax |
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Authorized Official
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Title or Position | ENTERPRISE EVP
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Name | SCOTT RISSMILLER
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Credential |
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Telephone | 704-355-8675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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