| Archwell Health Professional Services Of North Carolina, P.c. | |
|
3022 Eastway Dr Ste 1-3 Charlotte NC 28205-5642 | |
| (888) 987-1151 | |
| Not Available |
| Full Name | Archwell Health Professional Services Of North Carolina, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 3022 Eastway Dr Ste 1-3, Charlotte, North Carolina |
| Authorized Official Name and Position | Lisa Lucas (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 6154190947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Archwell Health Professional Services Of North Carolina, P.c. 102 Woodmont Blvd Ste 600 Nashville TN 37205-5250 Ph: () - | Archwell Health Professional Services Of North Carolina, P.c. 3022 Eastway Dr Ste 1-3 Charlotte NC 28205-5642 Ph: (888) 987-1151 |
| NPI Number | 1881278299 |
|---|---|
| Provider Enumeration Date | 05/11/2021 |
| Last Update Date | 04/05/2023 |
| Medicare PECOS PAC ID | 0446658652 |
|---|---|
| Medicare Enrollment ID | O20211001001005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881278299 | NPI | - | NPPES |
| Provider Name | Sandra Hope Raymore |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649771114 PECOS PAC ID: 0143584961 Enrollment ID: I20180503000253 |
| Provider Name | Jaydev Yashwant Jani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851559942 PECOS PAC ID: 7315013000 Enrollment ID: I20190812000950 |
| Provider Name | Linh Ngoc Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902302037 PECOS PAC ID: 7214331206 Enrollment ID: I20210812003853 |
| Provider Name | Spora Esunju |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104318831 PECOS PAC ID: 9739587965 Enrollment ID: I20211001001594 |
| Provider Name | Michael Jordan Lipp |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427016021 PECOS PAC ID: 3173678323 Enrollment ID: I20220118002077 |
| Provider Name | Naga L Pannala |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1366673352 PECOS PAC ID: 2365743556 Enrollment ID: I20220224001592 |
| Provider Name | Havon Knight |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972617744 PECOS PAC ID: 9032278692 Enrollment ID: I20220606001825 |
| Provider Name | Donald Joseph Goddard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134229412 PECOS PAC ID: 4486648664 Enrollment ID: I20220628000660 |
| Provider Name | Julia Funck |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1609335611 PECOS PAC ID: 4183950439 Enrollment ID: I20220906000165 |
| Provider Name | Todd Gracen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639397904 PECOS PAC ID: 3072406131 Enrollment ID: I20230911003150 |
| Provider Name | Ndidi Salami |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538832803 PECOS PAC ID: 0244690444 Enrollment ID: I20240318000279 |
| Provider Name | Evan T Trivette |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669601019 PECOS PAC ID: 3971941907 Enrollment ID: I20240409004305 |
| Provider Name | Raja Kumari Vaidadi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588918395 PECOS PAC ID: 4587974738 Enrollment ID: I20240424002749 |
| Provider Name | Kenya Mcintosh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396768578 PECOS PAC ID: 4183856974 Enrollment ID: I20240426000229 |
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