Healthcare Provider Details

I. General information

NPI: 1386753325
Provider Name (Legal Business Name): JONATHAN WILLIAM BUTLER MD, M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MEDICAL PLAZA DR STE 300
CHARLOTTE NC
28262-8702
US

IV. Provider business mailing address

9615 E 148TH ST STE 1
NOBLESVILLE IN
46060-4371
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-6561
  • Fax: 704-384-1977
Mailing address:
  • Phone: 317-574-1254
  • Fax: 317-674-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01070077A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-00264
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number26897
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26897
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number01070077A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: