MEDICARE: CAROLINA FAMILY CARE, 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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306252069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA FAMILY CARE, INC

Provider Business Mailing Address
First Line	:	PO BOX 602108
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2108
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 BEN SAWYER BLVD
Second Line	:	STE 1109-1111
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-5525
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KARYN RAE
Credential	:
Telephone Number	:	843-876-1344

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	01/09/2019

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