Healthcare Provider Details

I. General information

NPI: 1275340572
Provider Name (Legal Business Name): DRDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 SPRINGBANK LN STE 140
CHARLOTTE NC
28226-3363
US

IV. Provider business mailing address

1235 EAST BLVD. ST E-266 E-266
CHARLOTTE NC
28203
US

V. Phone/Fax

Practice location:
  • Phone: 704-702-6555
  • Fax: 704-702-6555
Mailing address:
  • Phone: 813-482-8203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS DENAE FREDERICK
Title or Position: MANAGER
Credential:
Phone: 813-482-8203