MEDICARE: CAROLINAS PHYSICIANS NETWORK INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	208600000X	Surgery Physician
3	207R00000X	Internal Medicine Physician
4	207X00000X	Orthopaedic Surgery Physician
5	207VM0101X	Maternal & Fetal Medicine Physician
6	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
7	207RS0010X	Sports Medicine (Internal Medicine) Physician
8	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
9	207RP1001X	Pulmonary Disease Physician
10	208100000X	Physical Medicine & Rehabilitation Physician
11	106H00000X	Marriage & Family Therapist
12	207XS0106X	Orthopaedic Hand Surgery Physician
13	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1518405257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS PHYSICIANS NETWORK INC

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:	704-631-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	16645 BIRKDALE COMMONS PKWY
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-5669
Country	:	US
Telephone Number	:	704-863-4878
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT RISSMILLER
Credential	:	MD
Telephone Number	:	704-631-0002

Provider Enumeration Date	:	02/02/2017
Last Update Date	:	06/09/2026

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