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General NPI Number Information
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NPI Number | 1578597555
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Entity Type | Organization
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Legal Business Name | SENIOR HEALTH CONNECTION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7903 PROVIDENCE RD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28277-9720
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Country | US
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Telephone | 704-543-4360
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Fax | 704-544-2385
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Provider Business Mailing Address
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Address Line | 5000 AIRPORT CENTER PKWY STE A
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City | CHARLOTTE
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State | NC
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Zip | 28208-5899
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Country | US
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Telephone | 704-512-4116
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Fax | 704-371-7284
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DANIEL L. WIENS
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Credential |
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Telephone | 704-355-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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