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NPI Code Detail

MEDICARE: CAROMONT MEDICAL GROUP INC

MEDICARE: CAROMONT MEDICAL GROUP INC
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102746OTHERNCBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245419845
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROMONT MEDICAL GROUP INC
Provider Business Mailing Address
First Line : PO BOX 744786
Second Line :
City : ATLANTA
State : GA
Zip : 30374-4786
Country : US
Telephone Number : 704-834-2450
Fax Number : 704-671-5331
Provider Business Practice Location Address
First Line : 700 N MAIN ST
Second Line :
City : STANLEY
State : NC
Zip : 28164-1438
Country : US
Telephone Number : 704-263-8945
Fax Number : 704-263-2591
Authorized Official
Title or Position : CFO
Name : DAVID OCONNOR
Credential :
Telephone Number : 704-834-2049
Provider Enumeration Date : 10/31/2007
Last Update Date : 08/09/2022

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Directions to “CAROMONT MEDICAL GROUP INC ” Practice Location

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