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General NPI Number Information
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NPI Number | 1821521451
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Entity Type | Organization
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Legal Business Name | PRESTIGE HEALTH & WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/23/2017
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Provider Practice Location Address
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Address Line | 2711 RANDOLPH RD SUITE 207
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City | CHARLOTTE
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State | NC
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Zip | 28207-2034
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Country | US
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Telephone | 704-910-5982
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Fax | 704-733-9796
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Provider Business Mailing Address
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Address Line | 2711 RANDOLPH RD SUITE 207
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City | CHARLOTTE
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State | NC
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Zip | 28207-2034
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Country | US
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Telephone | 704-910-5982
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Fax | 704-733-9796
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Authorized Official
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Title or Position | FAMILY PRACTITIONER
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Name | DR. DEVON M RAMBERT-HAIRSTON
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Credential | DNP
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Telephone | 704-910-5982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5004878
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License Number State | NC
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