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General NPI Number Information
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NPI Number | 1164113718
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Entity Type | Organization
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Legal Business Name | MECKLENBURG DYNAMIC SOLUTIONS, LTD. LIABILITY CO
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 5014 CROSS ST
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City | CHARLOTTE
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State | NC
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Zip | 28269-4108
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Country | US
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Telephone | 856-503-5389
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Fax |
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Provider Business Mailing Address
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Address Line | 5014 CROSS ST
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City | CHARLOTTE
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State | NC
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Zip | 28269-4108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TANATILIE KIRKLAND
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Credential | PBT
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Telephone | 856-503-5389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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