Healthcare Provider Details

I. General information

NPI: 1083667877
Provider Name (Legal Business Name): DONALD STANLEY HORNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD #201
CHARLOTTE NC
28211
US

IV. Provider business mailing address

330 BILLINGSLEY RD #201
CHARLOTTE NC
28211
US

V. Phone/Fax

Practice location:
  • Phone: 704-366-8400
  • Fax: 704-366-8499
Mailing address:
  • Phone: 704-366-8400
  • Fax: 704-366-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26269
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: