Healthcare Provider Details

I. General information

NPI: 1720721061
Provider Name (Legal Business Name): MARIANNE MORRIS LIGON MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10628 PARK RD
CHARLOTTE NC
28210-8407
US

IV. Provider business mailing address

6135 PARK SOUTH DR STE 510
CHARLOTTE NC
28210-0100
US

V. Phone/Fax

Practice location:
  • Phone: 704-667-1000
  • Fax:
Mailing address:
  • Phone: 704-304-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2026-03213
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: