Provider Demographics
NPI:1275781726
Name:CAROLINAS PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:CAROLINAS PHYSICIANS NETWORK, INC.
Other - Org Name:CAROLINA FAMILY MEDICINE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-355-0648
Mailing Address - Street 1:PO BOX 602124
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2124
Mailing Address - Country:US
Mailing Address - Phone:704-662-3627
Mailing Address - Fax:704-662-3229
Practice Address - Street 1:478 WILLIAMSON ROAD
Practice Address - Street 2:STE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9109
Practice Address - Country:US
Practice Address - Phone:704-662-3627
Practice Address - Fax:704-662-3229
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINAS PHYSICIANS NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty