Healthcare Provider Details

I. General information

NPI: 1508182361
Provider Name (Legal Business Name): NEAD MEDICAL PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10504 PARK RD
CHARLOTTE NC
28210-8405
US

IV. Provider business mailing address

10504 PARK RD
CHARLOTTE NC
28210-8405
US

V. Phone/Fax

Practice location:
  • Phone: 704-319-9045
  • Fax: 704-319-9046
Mailing address:
  • Phone: 704-319-9045
  • Fax: 704-319-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number97-01215
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number97-01215
License Number StateNC

VIII. Authorized Official

Name: DR. ADEWUNMI AKANDE
Title or Position: MRDICAL DIRECTOR
Credential: MD
Phone: 704-319-9045