Healthcare Provider Details

I. General information

NPI: 1811382336
Provider Name (Legal Business Name): MR. WILLIAM C. SYKES III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20409 STAGHORN CT
CORNELIUS NC
28031-7185
US

IV. Provider business mailing address

20409 STAGHORN CT
CORNELIUS NC
28031-7185
US

V. Phone/Fax

Practice location:
  • Phone: 704-608-6974
  • Fax: 704-892-3934
Mailing address:
  • Phone: 704-608-6974
  • Fax: 704-892-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: