=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790179505
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PACS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2015
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10021 PARK CEDAR DR STE 200
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28210-8701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-438-9383
-----------------------------------------------------
Fax | 704-438-9383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10021 PARK CEDAR DR STE 200
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28210-8701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-438-9383
-----------------------------------------------------
Fax | 704-438-9383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / MEDICAL DIRECTOR/PHYSICIAN
-----------------------------------------------------
Name | DR. HOLLY LAYMAN BERNARDINI
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 704-438-9383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------