Healthcare Provider Details

I. General information

NPI: 1215107834
Provider Name (Legal Business Name): CHARLOTTE WOMENS PAVILION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 RANDOLPH RD SUITE 206
CHARLOTTE NC
28207-1105
US

IV. Provider business mailing address

PO BOX 24848
WINSTON SALEM NC
27114-4848
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-3308
  • Fax: 704-332-3358
Mailing address:
  • Phone: 336-714-2500
  • Fax: 336-714-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22208
License Number StateNC

VIII. Authorized Official

Name: CHARLES CHIKE ANIKWUE
Title or Position: OWNER
Credential: M.D.
Phone: 704-332-3308