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General NPI Number Information
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NPI Number | 1346452927
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Entity Type | Organization
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Legal Business Name | CHARLOTTE RECONSTRUCTIVE SURGERY, PLLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2215 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28207-1523
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Country | US
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Telephone | 704-971-1438
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Fax | 704-688-3899
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Provider Business Mailing Address
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Address Line | 2215 RANDOLPH RD
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City | CHARLOTTE
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State | NC
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Zip | 28207-1523
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Country | US
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Telephone | 704-971-1438
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Fax | 704-688-3899
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Authorized Official
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Title or Position | ACCOUNTING MANAGER
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Name | MILLY MOORE
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Credential |
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Telephone | 704-971-1438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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