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101 E W T Harris Blvd Suite 4104 Charlotte NC 28262-3485 | |
| (704) 863-3300 | |
| (704) 512-3980 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 101 E W T Harris Blvd, Charlotte, North Carolina |
| Authorized Official Name and Position | Daniel L Wiens (SVP/OPERATIONS CPN) |
| Authorized Official Contact | 7043550648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 601643 Charlotte NC 28260-1643 Ph: (704) 863-3300 | 101 E W T Harris Blvd Suite 4104 Charlotte NC 28262-3485 Ph: (704) 863-3300 |
| NPI Number | 1366866642 |
|---|---|
| Provider Enumeration Date | 02/07/2014 |
| Last Update Date | 02/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366866642 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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