MEDICARE: CARTERS CIRCLE OF CARE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	363LF0000X	Family Nurse Practitioner
3	261QP2300X	Primary Care Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	261QM1300X	Multi-Specialty Clinic/Center
7	261QM0850X	Adult Mental Health Clinic/Center
8	207QA0505X	Adult Medicine Physician
9	207KA0200X	Allergy Physician
10	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1245462993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTERS CIRCLE OF CARE, INC.

Provider Business Mailing Address
First Line	:	2031 MARTIN LUTHER KING JR DR
Second Line	:	SUITE E
City	:	GREENSBORO
State	:	NC
Zip	:	27406-3342
Country	:	US
Telephone Number	:	336-271-5888
Fax Number	:	336-271-5882

Provider Business Practice Location Address
First Line	:	2031 MARTIN LUTHER KING JR DR
Second Line	:	SUITE E
City	:	GREENSBORO
State	:	NC
Zip	:	27406-3342
Country	:	US
Telephone Number	:	336-254-8843
Fax Number	:	336-271-5888

Authorized Official
Title or Position	:	QUALIFIED PROFESSIONAL
Name	:	MRS. ERICA DAWN CARTER
Credential	:
Telephone Number	:	336-271-5888

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	04/15/2015

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