Healthcare Provider Details

I. General information

NPI: 1952487977
Provider Name (Legal Business Name): JESSICA S SAXE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROZZELLES FERRY RD
CHARLOTTE NC
28208-4228
US

IV. Provider business mailing address

PO BOX 602478
CHARLOTTE NC
28260-2478
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-9987
  • Fax: 704-350-1113
Mailing address:
  • Phone: 704-446-9987
  • Fax: 704-350-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22970
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: