Healthcare Provider Details

I. General information

NPI: 1467314955
Provider Name (Legal Business Name): YONIS MOHAMED AHMED FADLALMULA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 REESE FURR DR
CHARLOTTE NC
28216-1994
US

IV. Provider business mailing address

6908 REESE FURR DR
CHARLOTTE NC
28216-1994
US

V. Phone/Fax

Practice location:
  • Phone: 704-406-7057
  • Fax:
Mailing address:
  • Phone: 704-406-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number42550985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: