Healthcare Provider Details

I. General information

NPI: 1487594271
Provider Name (Legal Business Name): ALTAVERA BEHAVIORAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 COPPERFIELD BLVD NE STE 200
CONCORD NC
28025-2427
US

IV. Provider business mailing address

432 COPPERFIELD BLVD NE STE 200
CONCORD NC
28025-2427
US

V. Phone/Fax

Practice location:
  • Phone: 704-906-9573
  • Fax:
Mailing address:
  • Phone: 704-906-9573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN KEITH STOUDMIRE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 704-906-9573