Healthcare Provider Details

I. General information

NPI: 1821343807
Provider Name (Legal Business Name): BENJAMIN CRAIG SIGMON C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 7TH ST SUITE I
CHARLOTTE NC
28204-3311
US

IV. Provider business mailing address

2001 E 7TH ST SUITE I
CHARLOTTE NC
28204-3311
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-1860
  • Fax: 704-347-2785
Mailing address:
  • Phone: 704-334-1860
  • Fax: 704-347-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO005138
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: