MEDICARE: HEALTHCARE OF THE CAROLINAS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1194687285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE OF THE CAROLINAS, LLC

Provider Business Mailing Address
First Line	:	1750 HIGHWAY 160 W STE 101-259
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8009
Country	:	US
Telephone Number	:	803-681-0158
Fax Number	:	928-218-6384

Provider Business Practice Location Address
First Line	:	2260 VISTA RD
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-7800
Country	:	US
Telephone Number	:	839-400-2400
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/HOSPITALIST
Name	:	COREY WILSON
Credential	:	MD
Telephone Number	:	803-681-0158

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	12/28/2025

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