Basic Information
Provider Information
NPI: 1366882391
EntityType: 2
ReplacementNPI:  
OrganizationName: FIRST HEALTH OF THE CAROLINAS INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FIRSTHEALTH INFECTIOUS DISEASES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 896208
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282896208
CountryCode: US
TelephoneNumber: 9107151010
FaxNumber: 9107151026
Practice Location
Address1: 35 MEMORIAL DR
Address2:  
City: PINEHURST
State: NC
PostalCode: 283748708
CountryCode: US
TelephoneNumber: 9107155481
FaxNumber: 9107155745
Other Information
ProviderEnumerationDate: 07/05/2013
LastUpdateDate: 01/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FOSTER
AuthorizedOfficialFirstName: MICKEY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 9107151913
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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