Healthcare Provider Details

I. General information

NPI: 1720993553
Provider Name (Legal Business Name): MY VA DOCTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 ARROWRIDGE BLVD STE 1A-9
CHARLOTTE NC
28273-5755
US

IV. Provider business mailing address

8350 ARROWRIDGE BLVD STE 1A-9
CHARLOTTE NC
28273-5755
US

V. Phone/Fax

Practice location:
  • Phone: 678-448-6776
  • Fax:
Mailing address:
  • Phone: 678-448-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC DOHERTY
Title or Position: CEO
Credential:
Phone: 678-448-6776