Healthcare Provider Details

I. General information

NPI: 1720726193
Provider Name (Legal Business Name): AVANT WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 MONROE ROAD
CHARLOTTE NC
28270-1471
US

IV. Provider business mailing address

9835 MONROE ROAD
CHARLOTTE NC
28270-1471
US

V. Phone/Fax

Practice location:
  • Phone: 704-537-0909
  • Fax: 704-537-0947
Mailing address:
  • Phone: 704-537-0909
  • Fax: 704-537-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN B LEWIS
Title or Position: MEMBER
Credential: MD
Phone: 704-537-0909