Healthcare Provider Details

I. General information

NPI: 1063554517
Provider Name (Legal Business Name): MECKLENBURG COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 BILLINGSLEY RD
CHARLOTTE NC
28211-1003
US

IV. Provider business mailing address

249 BILLINGSLEY RD
CHARLOTTE NC
28211-1003
US

V. Phone/Fax

Practice location:
  • Phone: 704-336-4776
  • Fax: 704-336-5006
Mailing address:
  • Phone: 704-336-4776
  • Fax: 704-336-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYNARD E WASHINGTON
Title or Position: HEALTH DIRECTOR
Credential: PHD
Phone: 980-579-0671