Healthcare Provider Details

I. General information

NPI: 1699698654
Provider Name (Legal Business Name): DAVID HAMILTON DRAKE JR. MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 JAY ST
CHARLOTTE NC
28208-4459
US

IV. Provider business mailing address

210 S MAIN ST APT 526
KANNAPOLIS NC
28081-3233
US

V. Phone/Fax

Practice location:
  • Phone: 704-467-2500
  • Fax:
Mailing address:
  • Phone: 704-467-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP576753
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: