Healthcare Provider Details

I. General information

NPI: 1831575935
Provider Name (Legal Business Name): MISSION MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HOSPITAL DR
CLYDE NC
28721-0107
US

IV. Provider business mailing address

PO BOX 602998
CHARLOTTE NC
28260-2998
US

V. Phone/Fax

Practice location:
  • Phone: 828-252-7331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL HOGGARD-GREEN
Title or Position: PRESIDENT
Credential: PHD
Phone: 828-213-9637