MEDICARE: CAROMONT- SOUTH POINT LLC

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	:	1932388568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROMONT- SOUTH POINT LLC

Provider Business Mailing Address
First Line	:	159 E DALLAS RD
Second Line	:
City	:	STANLEY
State	:	NC
Zip	:	28164-2052
Country	:	US
Telephone Number	:	704-263-0300
Fax Number	:	704-263-1873

Provider Business Practice Location Address
First Line	:	159 E DALLAS RD
Second Line	:
City	:	STANLEY
State	:	NC
Zip	:	28164-2052
Country	:	US
Telephone Number	:	704-263-0300
Fax Number	:	704-263-1873

Authorized Official
Title or Position	:	CFO
Name	:	DAVID M OCONNOR
Credential	:
Telephone Number	:	704-834-2133

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	04/25/2019

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Directions to “CAROMONT- SOUTH POINT LLC ” Practice Location

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