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General NPI Number Information
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NPI Number | 1528320702
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Entity Type | Organization
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Legal Business Name | MEDICAL ATHLETICS LLC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 08/06/2012
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Provider Practice Location Address
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Address Line | 8535 CLIFF CAMERON DR SUITE 116
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City | CHARLOTTE
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State | NC
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Zip | 28269-5908
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Country | US
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Telephone | 704-557-0132
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Fax | 877-284-0039
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Provider Business Mailing Address
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Address Line | 3020 PROSPERITY CHURCH RD SUITE I #174
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City | CHARLOTTE
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State | NC
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Zip | 28269-7197
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Country | US
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Telephone | 704-557-0132
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Fax | 877-284-0039
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Authorized Official
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Title or Position | SENIOR EXECUTIVE FOR HEALTHCARE ADM
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Name | MS. SHADAWN STOKES
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Credential | MHSA
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Telephone | 704-557-0132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State | NC
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