Healthcare Provider Details

I. General information

NPI: 1780813147
Provider Name (Legal Business Name): VERNON EUGENE MACKIE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15830 BALLANTYNE MEDICAL PL
CHARLOTTE NC
28277-4653
US

IV. Provider business mailing address

15830 BALLANTYNE MEDICAL PL
CHARLOTTE NC
28277-4653
US

V. Phone/Fax

Practice location:
  • Phone: 980-442-9600
  • Fax: 980-442-9708
Mailing address:
  • Phone: 980-442-9600
  • Fax: 980-442-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2018-00934
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: