Healthcare Provider Details

I. General information

NPI: 1164412458
Provider Name (Legal Business Name): KAROL DIANE DOWNING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 10/25/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 MALLARD CREEK RD
CHARLOTTE NC
28262-9786
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-510-8000
  • Fax:
Mailing address:
  • Phone: 704-510-8000
  • Fax: 704-510-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102341
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102341
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: