Healthcare Provider Details

I. General information

NPI: 1760453070
Provider Name (Legal Business Name): RYAN HINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 FAIRVIEW RD
MOORESVILLE NC
28117-9500
US

IV. Provider business mailing address

3101 LATROBE DR
CHARLOTTE NC
28211-4849
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-4000
  • Fax:
Mailing address:
  • Phone: 704-376-7362
  • Fax: 704-376-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2005-00619
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number200500619
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: