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NPI Code Detail

MEDICARE: CAROLINA HEALTHCARE ASSOCIATES INC

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
1207R00000XInternal Medicine Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1558684001
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAROLINA HEALTHCARE ASSOCIATES 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 : 1135 MILITARY CUTOFF RD
Second Line : SUITE 103
City : WILMINGTON
State : NC
Zip : 28405-3966
Country : US
Telephone Number : 910-256-6222
Fax Number :
Authorized Official
Title or Position : VICE-PRESIDENT
Name : DANIEL GOODWIN
Credential :
Telephone Number : 910-667-7597
Provider Enumeration Date : 03/11/2010
Last Update Date : 02/27/2019

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Directions to “CAROLINA HEALTHCARE ASSOCIATES INC ” Practice Location

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