Healthcare Provider Details

I. General information

NPI: 1952703027
Provider Name (Legal Business Name): JIM COATES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2014
Last Update Date: 09/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TYVOLA RD
CHARLOTTE NC
28217-3504
US

IV. Provider business mailing address

500 TYVOLA RD
CHARLOTTE NC
28217-3504
US

V. Phone/Fax

Practice location:
  • Phone: 704-501-2402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number14077
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: