# CAROLINA MEDICORP ENTERPRISES, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CAROLINA MEDICORP ENTERPRISES, INC
- **Other names:** Primce care of Kernersville
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710945696
- **Legal business name:** CAROLINA MEDICORP ENTERPRISES, INC
- **Authorized official:** PAUL M. BARRY MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (336) 774-0040

## Contact information

- **Practice address:** 111 GATEWAY CENTER DR, DBA PRIMECARE KERNERSVILLE, KERNERSVILLE, NC 27284-2999
- **Practice address phone:** (336) 996-2173
- **Practice address fax:** (336) 996-3254
- **Mailing address:** 2000 FRONTIS PLAZA BLVD STE 200, (ATTN) FORSYTH MEDICAL GROUP, WINSTON SALEM, NC 27103-5616
- **Mailing address phone:** (336) 277-2435
- **Mailing address fax:** (336) 277-9275

## 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 |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 10/09/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 89012M | — | NC |