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General NPI Number Information
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NPI Number | 1629322292
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Entity Type | Organization
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Legal Business Name | SOUTH EAST MECKLENBURG COUNTY HEALTH DEPARTMENT
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 429 BILLINGSLEY ROAD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1089
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Country | US
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Telephone | 704-336-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 429 BILLINGSLEY ROAD
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City | CHARLOTTE
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State | NC
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Zip | 28211-1089
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Country | US
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Telephone | 704-336-6404
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PHILIP RICHARD ENDRESS
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Credential |
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Telephone | 704-336-8638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | NC
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