Healthcare Provider Details

I. General information

NPI: 1578887972
Provider Name (Legal Business Name): NORTHCROSS OBSTETRIC AND GYNECOLOGIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 COULOAK DR SUITE 201
CHARLOTTE NC
28216-8678
US

IV. Provider business mailing address

PO BOX 601067
CHARLOTTE NC
28260-1067
US

V. Phone/Fax

Practice location:
  • Phone: 704-801-2075
  • Fax: 704-801-2076
Mailing address:
  • Phone: 704-801-2075
  • Fax: 704-801-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. THOMAS FORD LAYMON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 704-446-8250