NPIMap

Organization Active NPI

Carolina Advanced Wellness, PLLC

  • Internal Medicine Physician
  • Charlotte, NC
National Provider Identifier
1235710211
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAROLINA ADVANCED WELLNESS, PLLC
Practice address
309 S Sharon Amity Rd Ste 102
Charlotte, NC 28211-2886
Phone
(704) 247-8355
NPI assigned
Apr 20, 2021
Last updated
Apr 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerry Allen SaundersNPI 1306137526
Title
Owner
Phone
(704) 316-5635

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

309 S Sharon Amity Rd Ste 102
Charlotte, NC 28211-2886

Mailing address

11035 Golf Links Dr # 79217
Charlotte, NC 28277-8045
Phone (704) 247-8355

National Provider Directory

National Provider Directory
Tax ID family
Carolina Advanced Wellness PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1235710211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11035 GOLF LINKS DR # 79217",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282778045",
            "telephone_number": "704-247-8355",
            "fax_number": "704-247-8355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S SHARON AMITY RD STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112886",
            "telephone_number": "704-247-8355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA ADVANCED WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "SAUNDERS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-316-5635"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.