Healthcare Provider Details

I. General information

NPI: 1659500072
Provider Name (Legal Business Name): JOHNNY ABRAHAM DIAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 HARDING PLACE SUITE 2600
CHARLOTTE NC
28204
US

IV. Provider business mailing address

1237 HARDING PLACE SUITE 2600
CHARLOTTE NC
28204
US

V. Phone/Fax

Practice location:
  • Phone: 704-468-3100
  • Fax: 704-468-3120
Mailing address:
  • Phone: 704-468-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberUNLICENSED
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0102202781
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37770
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37770
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2014-00110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: