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General NPI Number Information
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NPI Number | 1235208018
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Entity Type | Individual
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Provider Name | KAMLA TERESE JAIN MD
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 309 S SHARON AMITY RD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28211-2978
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Country | US
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Telephone | 704-446-2360
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Fax | 704-366-3746
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Provider Business Mailing Address
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Address Line | ASU STUDENT HEALTH CENTER 614 HOWARD STREET, MILES ANNAS BLDG
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City | BOONE
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State | NC
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Zip | 28608
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Country | US
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Telephone | 704-446-2360
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Fax | 704-366-3746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200000471
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2000-00471
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License Number State | NC
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