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	License Number	License Number State
1	207Q00000X	Family Medicine 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

General Provider Information

NPI Number	:	1619371697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS PHYSICIANS NETWORK, INC.

Provider Business Mailing Address
First Line	:	PO BOX 601888
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1888
Country	:	US
Telephone Number	:	704-888-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 STANLY PKWY
Second Line	:	SUITE A
City	:	LOCUST
State	:	NC
Zip	:	28097-7710
Country	:	US
Telephone Number	:	704-888-0580
Fax Number	:

Authorized Official
Title or Position	:	SVP
Name	:	MR. THOMAS FORD LAYMON
Credential	:
Telephone Number	:	704-631-0002

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	08/12/2016

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