Healthcare Provider Details

I. General information

NPI: 1033711171
Provider Name (Legal Business Name): FREDRICK HUFFIN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 REAGAN DR STE 3
CHARLOTTE NC
28206-1392
US

IV. Provider business mailing address

4000 SELDA DR
WINSTON SALEM NC
27107-3779
US

V. Phone/Fax

Practice location:
  • Phone: 704-412-1931
  • Fax:
Mailing address:
  • Phone: 336-926-7975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: