Healthcare Provider Details

I. General information

NPI: 1447388517
Provider Name (Legal Business Name): PRESBYTERIAN WOMEN'S CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD SUITE 300
CHARLOTTE NC
28207-1112
US

IV. Provider business mailing address

PO BOX 602362
CHARLOTTE NC
28260-2362
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-5675
  • Fax: 704-335-8163
Mailing address:
  • Phone: 704-377-5675
  • Fax: 704-335-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEOFFREY K. GARDNER
Title or Position: VP OF FINANCE
Credential:
Phone: 704-384-9094