Healthcare Provider Details

I. General information

NPI: 1306817242
Provider Name (Legal Business Name): DR. JOHN AREY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E. 5TH ST. STE 110
CHARLOTTE NC
28204-2472
US

IV. Provider business mailing address

7110 EDENDERRY DR
CHARLOTTE NC
28270-3806
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-5354
  • Fax: 704-375-3069
Mailing address:
  • Phone: 704-375-5354
  • Fax: 704-375-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0059
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: