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General NPI Number Information
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NPI Number | 1609880566
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Entity Type | Organization
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Legal Business Name | OWEIDA AND CHRISTIAN ORTHOPAEDIC & SPORTS MEDICINE,PA
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 3541 RANDOLPH RD SUITE 210
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City | CHARLOTTE
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State | NC
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Zip | 28211-1082
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Country | US
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Telephone | 704-944-0143
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Fax | 704-944-7399
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Provider Business Mailing Address
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Address Line | 3541 RANDOLPH RD SUITE 210
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City | CHARLOTTE
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State | NC
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Zip | 28211-1082
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Country | US
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Telephone | 704-944-0143
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Fax | 704-944-7399
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | BRENDA ELAINE HAGLER
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Credential |
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Telephone | 704-944-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28788
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 201593
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License Number State | NC
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