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General NPI Number Information
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NPI Number | 1154690931
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Entity Type | Organization
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Legal Business Name | METRO MEDICAL HOUSE CALLS,PC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 1709 EAST BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-5823
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Country | US
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Telephone | 704-333-6642
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Fax | 704-332-6642
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Provider Business Mailing Address
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Address Line | PO BOX 36388
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City | CHARLOTTE
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State | NC
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Zip | 28236-6388
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Country | US
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Telephone | 304-252-6339
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EDGAR STUART CORNETT
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Credential | M.D.
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Telephone | 304-252-6369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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