Healthcare Provider Details

I. General information

NPI: 1699682534
Provider Name (Legal Business Name): JEROME CARLTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 THE PLZ STE C
CHARLOTTE NC
28215-1918
US

IV. Provider business mailing address

7320 THE PLZ STE C
CHARLOTTE NC
28215-1918
US

V. Phone/Fax

Practice location:
  • Phone: 704-352-1098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: