Healthcare Provider Details

I. General information

NPI: 1538845599
Provider Name (Legal Business Name): JESSIE NICOLE FOGLIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9908 COULOAK DR STE 103
CHARLOTTE NC
28216-8678
US

IV. Provider business mailing address

11828 KENNON RIDGE LN
HUNTERSVILLE NC
28078-3701
US

V. Phone/Fax

Practice location:
  • Phone: 704-801-2025
  • Fax:
Mailing address:
  • Phone: 512-557-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: