Healthcare Provider Details

I. General information

NPI: 1639195241
Provider Name (Legal Business Name): MECKLENBURG COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROZZELLES FERRY RD
CHARLOTTE NC
28208-4228
US

IV. Provider business mailing address

1801 ROZZELLES FERRY RD
CHARLOTTE NC
28208-4228
US

V. Phone/Fax

Practice location:
  • Phone: 704-350-7305
  • Fax: 704-350-7304
Mailing address:
  • Phone: 704-350-7305
  • Fax: 704-350-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: EARL WINTERS MABRY
Title or Position: HEALTH DIRECTOR
Credential: MD
Phone: 704-336-2299