=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518245752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NC PSYCHIATRIC ASSOCIATES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2011
-----------------------------------------------------
Last Update Date | 07/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3623 LATROBE DR SUITE #121
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-4864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-375-7579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3623 LATROBE DR SUITE #121
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28211-4864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-375-7579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PAMELA J. WRIGHT-ETTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 704-375-7579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 32917
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------