Provider Demographics
NPI:1962426726
Name:CAROLINA WOMEN'S WELLNESS CENTER
Entity type:Organization
Organization Name:CAROLINA WOMEN'S WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-985-1779
Mailing Address - Street 1:929 N 2ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3363
Mailing Address - Country:US
Mailing Address - Phone:704-985-1779
Mailing Address - Fax:704-985-1636
Practice Address - Street 1:929 N 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3363
Practice Address - Country:US
Practice Address - Phone:704-985-1779
Practice Address - Fax:704-985-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015MTMedicaid
NC89015MTMedicaid