Provider Demographics
NPI:1902150832
Name:INFINITE WELLNESS OF THE CAROLINAS
Entity type:Organization
Organization Name:INFINITE WELLNESS OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-453-6335
Mailing Address - Street 1:103 COUNTRY CLUB DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2935
Mailing Address - Country:US
Mailing Address - Phone:704-792-2200
Mailing Address - Fax:
Practice Address - Street 1:2160 COMMERCE DR STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2839
Practice Address - Country:US
Practice Address - Phone:704-282-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6723360001Medicare NSC