Healthcare Provider Details

I. General information

NPI: 1801705546
Provider Name (Legal Business Name): DEMONTAY L THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 PARTHENON CT APT K
CHARLOTTE NC
28262-0268
US

IV. Provider business mailing address

10000 PARTHENON CT APT K
CHARLOTTE NC
28262-0268
US

V. Phone/Fax

Practice location:
  • Phone: 330-241-9814
  • Fax:
Mailing address:
  • Phone: 330-241-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: