Healthcare Provider Details

I. General information

NPI: 1154690931
Provider Name (Legal Business Name): METRO MEDICAL HOUSE CALLS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 EAST BLVD
CHARLOTTE NC
28203-5823
US

IV. Provider business mailing address

PO BOX 36388
CHARLOTTE NC
28236-6388
US

V. Phone/Fax

Practice location:
  • Phone: 704-333-6642
  • Fax: 704-332-6642
Mailing address:
  • Phone: 304-252-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDGAR STUART CORNETT
Title or Position: DOCTOR
Credential: M.D.
Phone: 304-252-6369