# THE CAROLINA MEN'S CLINIC

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

## Provider details

- **NPI number:** 1548666878
- **Authorized official:** MR. MICHAEL BEAUCHAINE PA (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (704) 981-4490

## Contact information

- **Practice address:** 122 GATEWAY BLVD STE D, MOORESVILLE, NC 28117-5544
- **Practice address phone:** (704) 981-4490
- **Mailing address:** 122 GATEWAY BLVD STE D, MOORESVILLE, NC 28117-5544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 0010-05337 | NC | Yes |

## Other

- **Enumeration date:** 11/13/2014
- **Last updated:** 11/13/2014