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General NPI Number Information
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NPI Number | 1912008327
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Entity Type | Organization
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Legal Business Name | CENTRAL CAROLINA MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 6404 ALBEMARLE RD SUITE J&K
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City | CHARLOTTE
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State | NC
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Zip | 28212-3800
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Country | US
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Telephone | 704-532-8884
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Fax | 704-532-8789
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Provider Business Mailing Address
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Address Line | 6404 ALBEMARLE RD SUITE J&K
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City | CHARLOTTE
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State | NC
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Zip | 28212-3800
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Country | US
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Telephone | 704-532-8884
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Fax | 704-532-8789
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Authorized Official
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Title or Position | PHYSICIAN
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Name | TUONG NGUYEN
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Credential | M.D.
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Telephone | 704-532-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2008-00070
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2000-00566
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License Number State | NC
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