Provider Demographics
NPI:1437288719
Name:CAROLINA FAMILY MEDICINE AND DERMATOLOGY
Entity Type:Organization
Organization Name:CAROLINA FAMILY MEDICINE AND DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-751-9120
Mailing Address - Street 1:3000 BETHESDA PL
Mailing Address - Street 2:SUITE 601
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3331
Mailing Address - Country:US
Mailing Address - Phone:919-751-9120
Mailing Address - Fax:919-751-9170
Practice Address - Street 1:3000 BETHESDA PL
Practice Address - Street 2:SUITE 601
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3331
Practice Address - Country:US
Practice Address - Phone:919-751-9120
Practice Address - Fax:919-751-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8927324Medicaid
NC2279954Medicare PIN