# CAROLINA PINES MEDICAL, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carolina Pines Wellness Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164677332
- **Authorized official:** DR. MICHAEL PATRICK SHUSKO M.D. (PRESIDENT)
- **Authorized official phone:** (910) 347-5444

## Contact information

- **Practice address:** 3215 HENDERSON DR, JACKSONVILLE, NC 28546-5251
- **Practice address phone:** (910) 347-5444
- **Mailing address:** 3215 HENDERSON DR, JACKSONVILLE, NC 28546-5251
- **Mailing address phone:** (910) 347-5444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 200301290 | NC | Yes |
| 261QM2500X | Medical Specialty Clinic/Center | 200301290 | NC | — |

## Other

- **Enumeration date:** 12/01/2008
- **Last updated:** 02/10/2009