MEDICARE: CAROLINA DIAGNOSTICS, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1356547764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA DIAGNOSTICS, INC

Provider Business Mailing Address
First Line	:	60 CHASTAIN CENTER BLVD NW
Second Line	:	SUITE 66
City	:	KENNESAW
State	:	GA
Zip	:	30144-5598
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4109 STUART ANDREW BLVD STE H
Second Line	:	SUITE H
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1582
Country	:	US
Telephone Number	:	978-536-7400
Fax Number	:

Authorized Official
Title or Position	:	EVP-CFO
Name	:	CARL R IBERGER
Credential	:
Telephone Number	:	978-536-7400

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/22/2020

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