MEDICARE: ATLANTIC UROLOGY PC

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
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1851498208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC UROLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 30727
Second Line	:	DEPT 388
City	:	CHARLOTTE
State	:	NC
Zip	:	28230-0727
Country	:	US
Telephone Number	:	910-362-8765
Fax Number	:

Provider Business Practice Location Address
First Line	:	7655 MARKET ST
Second Line	:	SUITE A
City	:	WILMINGTON
State	:	NC
Zip	:	28411-9458
Country	:	US
Telephone Number	:	910-362-8765
Fax Number	:

Authorized Official
Title or Position	:	OWNER MD
Name	:	DR. RICHARD MYNATT
Credential	:	MD
Telephone Number	:	910-362-8765

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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