Basic Information
| Provider Information | |||||||||
| NPI: | 1659746576 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA MEDICORP ENTERPRISES INC | ||||||||
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| OtherOrganizationName: | NOVANT HEALTH EXPRESS CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751803 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364811970 | ||||||||
| FaxNumber: | 3368845012 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 N MAIN STREET | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272652735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364811970 | ||||||||
| FaxNumber: | 3368845012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2015 | ||||||||
| LastUpdateDate: | 12/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | GARDNER | ||||||||
| AuthorizedOfficialFirstName: | GEOFFREY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3364811970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.