MEDICARE: CAROLINA HEALTHCARE ASSOCIATES, 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	208800000X	Urology 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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467680587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA HEALTHCARE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 602484
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2484
Country	:	US
Telephone Number	:	910-254-1033
Fax Number	:	910-343-0171

Provider Business Practice Location Address
First Line	:	1333 S DICKINSON DR
Second Line	:	SUITE 230
City	:	LELAND
State	:	NC
Zip	:	28451-6430
Country	:	US
Telephone Number	:	910-254-1033
Fax Number	:	910-343-0171

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. DANIEL EUGENE GOODWIN
Credential	:
Telephone Number	:	910-667-7597

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	01/10/2017

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