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NPI Code Detail

MEDICARE: DR. DEIDRA MCCANTS GATLIN MD

MEDICARE: DR. DEIDRA MCCANTS GATLIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician200600998NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649253949
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEIDRA MCCANTS GATLIN MD
Provider Business Mailing Address
First Line : PO BOX 470408
Second Line :
City : CHARLOTTE
State : NC
Zip : 28247-0408
Country : US
Telephone Number : 704-375-0100
Fax Number : 704-335-3592
Provider Business Practice Location Address
First Line : 7845 LITTLE AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28226-8198
Country : US
Telephone Number : 704-375-0100
Fax Number : 704-335-3592
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 04/24/2018

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