Healthcare Provider Details

I. General information

NPI: 1548189475
Provider Name (Legal Business Name): MADELINE MOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 7TH ST UNIT A
CHARLOTTE NC
28204-4398
US

IV. Provider business mailing address

PO BOX 96897 UNIT A
CHARLOTTE NC
28296-6897
US

V. Phone/Fax

Practice location:
  • Phone: 704-998-0840
  • Fax: 704-376-2216
Mailing address:
  • Phone: 704-998-0840
  • Fax: 704-376-2216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16774
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: