Provider Demographics
NPI:1700965902
Name:CAROLINA CLINIC FOR DIGESTIVE DISEASES
Entity Type:Organization
Organization Name:CAROLINA CLINIC FOR DIGESTIVE DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CADDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-854-9990
Mailing Address - Street 1:1040 X RAY DR
Mailing Address - Street 2:STE B
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5438
Mailing Address - Country:US
Mailing Address - Phone:704-854-9990
Mailing Address - Fax:704-854-9045
Practice Address - Street 1:1040 X RAY DR
Practice Address - Street 2:STE B
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5438
Practice Address - Country:US
Practice Address - Phone:704-854-9990
Practice Address - Fax:704-854-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33956174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902001Medicaid
NC2160548AMedicare ID - Type Unspecified
NCE86900Medicare UPIN