Healthcare Provider Details

I. General information

NPI: 1548220726
Provider Name (Legal Business Name): JOSEPH PERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 W HIGHWAY 74 SUITE A
INDIAN TRAIL NC
28079-3468
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9701541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: