Healthcare Provider Details

I. General information

NPI: 1962894246
Provider Name (Legal Business Name): MISSION MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HOSPITAL DR
HIGHLANDS NC
28741-7600
US

IV. Provider business mailing address

PO BOX 602373
CHARLOTTE NC
28260-2373
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-4502
  • Fax: 828-213-4540
Mailing address:
  • Phone: 828-250-2833
  • Fax: 828-250-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL HOGGARD-GREEN
Title or Position: AUTHORIZED OFFICIAL
Credential: SENIOR VP
Phone: 828-213-1111