# CAROLINA MEDICORP ENTERPRISES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295106110
- **Authorized official:** GEOFFERY K GARDNER (VP OF FINANCE)
- **Authorized official phone:** (704) 384-7605

## Contact information

- **Practice address:** 50 W 4TH ST, SUITE 10, WINSTON-SALEM, NC 27101-4089
- **Practice address phone:** (336) 718-4705
- **Practice address fax:** (336) 718-4702
- **Mailing address:** PO BOX 751803, CHARLOTTE, NC 28275-1803
- **Mailing address phone:** (704) 384-7605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/19/2015
- **Last updated:** 02/14/2018