Healthcare Provider Details

I. General information

NPI: 1881374957
Provider Name (Legal Business Name): JOHN DEVERAUX HIGGINS RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

6047 CREFT CIR
INDIAN TRAIL NC
28079-9543
US

V. Phone/Fax

Practice location:
  • Phone: 704-466-0200
  • Fax:
Mailing address:
  • Phone: 704-388-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number9289
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: