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General NPI Number Information
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NPI Number | 1730100801
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Entity Type | Organization
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Legal Business Name | CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 13808 PROFESSIONAL CENTER DR
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-7948
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Country | US
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Telephone | 704-377-4009
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Fax |
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Provider Business Mailing Address
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Address Line | 2015 RANDOLPH RD SUITE 208
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City | CHARLOTTE
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State | NC
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Zip | 28207-1128
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Country | US
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Telephone | 704-377-4009
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Fax | 704-815-1655
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Authorized Official
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Title or Position | CEO
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Name | MRS. JENNIFER HICKS
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Credential |
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Telephone | 704-377-4009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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