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330 Billingsley Rd Suite 101 Charlotte NC 28211-5020 | |
| (704) 384-1605 | |
| (704) 384-1610 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 330 Billingsley Rd, Charlotte, North Carolina |
| Authorized Official Name and Position | Geoffery Gardner (VP FINANCE) |
| Authorized Official Contact | 7043847283 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 602362 Charlotte NC 28260-2362 Ph: (704) 384-1605 | 330 Billingsley Rd Suite 101 Charlotte NC 28211-5020 Ph: (704) 384-1605 |
| NPI Number | 1114967619 |
|---|---|
| Provider Enumeration Date | 06/07/2006 |
| Last Update Date | 07/31/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114967619 | NPI | - | NPPES |
| 015YP | Other | NC | BCBS NC |
| 89015YP | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (North Carolina) | Primary |
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