Healthcare Provider Details

I. General information

NPI: 1033248273
Provider Name (Legal Business Name): JENNIE JARVIS HAUSCHKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD STE 100
CHARLOTTE NC
28211-3096
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 500
CHARLOTTE NC
28210-3113
US

V. Phone/Fax

Practice location:
  • Phone: 704-405-3953
  • Fax:
Mailing address:
  • Phone: 704-495-6334
  • Fax: 844-624-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number133963
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number133963
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: