Healthcare Provider Details

I. General information

NPI: 1760260681
Provider Name (Legal Business Name): MONNIE JORDAN DRUMMOND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONNIE JORDAN DAVEY

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MATTHEWS ST
MATTHEWS NC
28105-4866
US

IV. Provider business mailing address

101 E MATTHEWS ST
MATTHEWS NC
28105-4866
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-6766
  • Fax: 704-332-6552
Mailing address:
  • Phone: 704-375-6766
  • Fax: 704-332-6552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13735
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: