=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457349227
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL D. SEXTON M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2005
-----------------------------------------------------
Last Update Date | 07/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8560 COOK ST
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28124-7686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-436-6521
-----------------------------------------------------
Fax | 704-436-9505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 602120
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-436-6521
-----------------------------------------------------
Fax | 704-436-9505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9701590
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------