Healthcare Provider Details

I. General information

NPI: 1780825539
Provider Name (Legal Business Name): MC FAMILY MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2009
Last Update Date: 01/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ALBEMARLE RD
CHARLOTTE NC
28212-3856
US

IV. Provider business mailing address

6700 ALBEMARLE RD
CHARLOTTE NC
28212-3856
US

V. Phone/Fax

Practice location:
  • Phone: 704-921-1000
  • Fax: 704-921-1022
Mailing address:
  • Phone: 704-921-1000
  • Fax: 704-921-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number001000864
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number34951
License Number StateNC

VIII. Authorized Official

Name: MRS. HUONG T NGUYEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 803-526-6069