Organization
CAROLINAS PHYSICIANS NETWORK INC.
Active
Parent organization
CAROLINAS PHYSICIANS NETWORK INC
Other names
Pine Lake Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINAS PHYSICIANS NETWORK INC
Authorized official
MR. DANIEL L. WIENS (SENIOR VICE PRESIDENT OF OPERATIONS)
(704) 355-0648
Entity
Organization
Contact information
Practice address
4105 MATTHEWS MINT HILL RD, MATTHEWS, NC 28105-3633
(704) 545-4609
(704) 545-4798
Mailing address
PO BOX 601949, CHARLOTTE, NC 28260-1949
(704) 545-4609
(704) 545-4798
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5908365
—
NC
Enumeration date
10/09/2007
Last updated
12/22/2010
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