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General NPI Number Information
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NPI Number | 1427726157
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Entity Type | Organization
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Legal Business Name | NCCRTEAM
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1911 SUGARBUSH DR
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City | CHARLOTTE
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State | NC
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Zip | 28214-1082
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Country | US
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Telephone | 704-493-1641
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 SUGARBUSH DR
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City | CHARLOTTE
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State | NC
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Zip | 28214-1082
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Country | US
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Telephone | 704-493-1641
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Fax |
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Authorized Official
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Title or Position | EXECUTOR
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Name | NATSHA JOHNSON
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Credential |
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Telephone | 704-493-1641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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