Healthcare Provider Details

I. General information

NPI: 1306420021
Provider Name (Legal Business Name): DILLON JAMES MACKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 VAIL AVE STE 200B
CHARLOTTE NC
28207-1222
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3668
  • Fax: 704-323-3948
Mailing address:
  • Phone: 704-696-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number93966
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2026-02006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: