Healthcare Provider Details

I. General information

NPI: 1841194735
Provider Name (Legal Business Name): PEDS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MOCKINGBIRD LN STE 4111
CHARLOTTE NC
28209-1170
US

IV. Provider business mailing address

907 E WORTHINGTON AVE
CHARLOTTE NC
28203-5757
US

V. Phone/Fax

Practice location:
  • Phone: 980-983-0643
  • Fax:
Mailing address:
  • Phone: 704-618-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHARLES J WILLIAMS III
Title or Position: CEO
Credential: MD
Phone: 704-618-4918