Healthcare Provider Details

I. General information

NPI: 1477581635
Provider Name (Legal Business Name): XIAOHUA LI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 10/26/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RANDOLPH RD STE 800
CHARLOTTE NC
28207
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1246
  • Fax: 704-384-6072
Mailing address:
  • Phone: 704-384-1246
  • Fax: 704-384-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21929
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018-02476
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2018-02476
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: