| Eastover Psychological & Psychiatric Group, Pa | |
|
3303 Latrobe Dr Charlotte NC 28211-4851 | |
| (704) 362-2663 | |
| (704) 362-2836 |
| Full Name | Eastover Psychological & Psychiatric Group, Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3303 Latrobe Dr, Charlotte, North Carolina |
| Authorized Official Name and Position | John Edward Humphrey (PRESIDENT) |
| Authorized Official Contact | 7043622663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastover Psychological & Psychiatric Group, Pa 3303 Latrobe Dr Charlotte NC 28211-4851 Ph: (704) 362-2663 | Eastover Psychological & Psychiatric Group, Pa 3303 Latrobe Dr Charlotte NC 28211-4851 Ph: (704) 362-2663 |
| NPI Number | 1366476681 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 05/02/2011 |
| Medicare PECOS PAC ID | 4880595933 |
|---|---|
| Medicare Enrollment ID | O20040412001652 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366476681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | David K Massey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023028222 PECOS PAC ID: 2860390549 Enrollment ID: I20031219000711 |
| Provider Name | Bradley Reddick |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457361859 PECOS PAC ID: 5496749533 Enrollment ID: I20110504000849 |
| Provider Name | Steven M Sutherland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720098213 PECOS PAC ID: 5698769735 Enrollment ID: I20110511000127 |
| Provider Name | John Humphrey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275575169 PECOS PAC ID: 7618961749 Enrollment ID: I20110519000620 |
| Provider Name | Richard Gellar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497799126 PECOS PAC ID: 9436143575 Enrollment ID: I20110519000733 |
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