Organization
CAROLINA MEDICORP ENTERPRISES, INC
Active
Parent organization
CAROLINA MEDICORP ENTERPRISES, INC
Other names
Primce care of Kernersville
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAROLINA MEDICORP ENTERPRISES, INC
Authorized official
PAUL M. BARRY MD (MEDICAL DIRECTOR)
(336) 774-0040
Entity
Organization
Contact information
Practice address
111 GATEWAY CENTER DR, DBA PRIMECARE KERNERSVILLE, KERNERSVILLE, NC 27284-2999
(336) 996-2173
(336) 996-3254
Mailing address
2000 FRONTIS PLAZA BLVD STE 200, (ATTN) FORSYTH MEDICAL GROUP, WINSTON SALEM, NC 27103-5616
(336) 277-2435
(336) 277-9275
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89012M
—
NC
Enumeration date
05/02/2006
Last updated
10/09/2007
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