Healthcare Provider Details

I. General information

NPI: 1295538379
Provider Name (Legal Business Name): CHARLOTTE FITNESS AND WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3758 S MAIN ST STE 300
HOPE MILLS NC
28348-1959
US

IV. Provider business mailing address

3626 LATROBE DR STE 300
CHARLOTTE NC
28211-1799
US

V. Phone/Fax

Practice location:
  • Phone: 910-429-0647
  • Fax:
Mailing address:
  • Phone: 704-366-7182
  • Fax: 704-366-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL ONAFOWOKAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 704-366-7182