Basic Information
| Provider Information | |||||||||
| NPI: | 1669778403 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA PHYSICIAN CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1689 | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287291689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288915524 | ||||||||
| FaxNumber: | 8288914069 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 E GROVER ST | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281503917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044728789 | ||||||||
| FaxNumber: | 8288914069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2011 | ||||||||
| LastUpdateDate: | 01/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | KELLY | ||||||||
| AuthorizedOfficialFirstName: | JOHNSON | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7044728789 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.