Provider Demographics
NPI:1952631491
Name:CAROLINA HEALTHCARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CAROLINA HEALTHCARE ASSOCIATES, INC.
Other - Org Name:MORGAN INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-667-7597
Mailing Address - Street 1:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-332-0241
Mailing Address - Fax:910-332-0246
Practice Address - Street 1:1333 S DICKINSON DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6430
Practice Address - Country:US
Practice Address - Phone:910-332-0241
Practice Address - Fax:910-332-0246
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA HEALTHCARE ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-06
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952631491Medicaid
NC5914202Medicaid
NC5914202Medicaid