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General NPI Number Information
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NPI Number | 1174465702
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Entity Type | Organization
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Legal Business Name | ALTAVERA BEHAVIORAL HEALTH PC
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Dates
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Enumeration Date | 04/06/2026
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Last Update Date | 04/06/2026
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Provider Practice Location Address
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Address Line | 432 COPPERFIELD BLVD NE STE 200
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City | CONCORD
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State | NC
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Zip | 28025-2427
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Country | US
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Telephone | 704-906-9573
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Fax |
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Provider Business Mailing Address
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Address Line | 432 COPPERFIELD BLVD NE STE 200
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City | CONCORD
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State | NC
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Zip | 28025-2427
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Country | US
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Telephone | 704-906-9573
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JONATHAN KEITH STOUDMIRE SR.
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Credential | MD
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Telephone | 704-699-5296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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