Healthcare Provider Details

I. General information

NPI: 1932698156
Provider Name (Legal Business Name): PREMIER SLEEP AND NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10009 PARK CEDAR DR STE 100
CHARLOTTE NC
28210-8935
US

IV. Provider business mailing address

10009 PARK CEDAR DR STE 100
CHARLOTTE NC
28210-8935
US

V. Phone/Fax

Practice location:
  • Phone: 704-412-7859
  • Fax: 833-973-4534
Mailing address:
  • Phone: 704-412-7859
  • Fax: 833-973-4534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number9400705
License Number StateNC

VIII. Authorized Official

Name: ROBERT L MCCLAIN
Title or Position: MANAGER
Credential:
Phone: 704-412-7859