ACNC Provider Orientation Registration - Tuesday, December 13, 2022: 12:00 - 1:00 p.m.

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* 1. Your organization or practice/ group name

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* 2. Your Name (First and Last)

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* 3. Title

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* 4. Practice Type

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* 5. Specialty

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* 6. Your organization or practice/ group NPI number

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* 7. Contact Information

Email Address *

Phone Number

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* 8. Is your organization contracted with AmeriHealth Caritas North Carolina?

Yes

No

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* 9. If not, would you like your Regional Account Executive to contact you about joining our network?

Yes

No

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* 10. This training session is an opportunity for your dedicated Account Executives to answer your questions about our plan. If you have questions about AmeriHealth Caritas North Carolina, please include them in the following comment box: