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1718 E 4th St Ste 207 Charlotte NC 28204-3291 | |
| (704) 384-7390 | |
| (704) 384-5669 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1718 E 4th St Ste 207, Charlotte, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: () - | 1718 E 4th St Ste 207 Charlotte NC 28204-3291 Ph: (704) 384-7390 |
| NPI Number | 1487297958 |
|---|---|
| Provider Enumeration Date | 10/28/2019 |
| Last Update Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487297958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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