# CAROLINAS PHYSICIANS NETWORK INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CAROLINAS PHYSICIANS NETWORK INC
- **Other names:** Indian Trail Family Medicine, Atrium Health Primary Care Indian Trail Family Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1134474059
- **Legal business name:** CAROLINAS PHYSICIANS NETWORK INC
- **Authorized official:** SCOTT RISSMILLER (ENTERPRISE EVP)
- **Authorized official phone:** (704) 355-8675

## Contact information

- **Practice address:** 4503 OLD MONROE RD, INDIAN TRAIL, NC 28079-5309
- **Practice address phone:** (980) 993-7100
- **Mailing address:** PO BOX 19305, CHARLOTTE, NC 28219-9305
- **Mailing address phone:** (704) 631-0002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 07/17/2012
- **Last updated:** 03/09/2023