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General NPI Number Information
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NPI Number | 1457638116
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Entity Type | Organization
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Legal Business Name | CHARLOTTE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 2700 PROVIDENCE RD S SUITE 320
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City | WAXHAW
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State | NC
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Zip | 28173-6313
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Country | US
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Telephone | 704-667-6750
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Fax | 704-667-6751
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Provider Business Mailing Address
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Address Line | PO BOX 601643
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City | CHARLOTTE
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State | NC
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Zip | 28260-1643
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Country | US
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Telephone | 704-667-6750
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Fax | 704-667-6751
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. THOMAS FORD LAYMON
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Credential |
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Telephone | 704-631-0002
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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 |
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License Number State |
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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 |
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License Number State | NC
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