MEDICARE: CALVARY COMMUNITY MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1356222483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVARY COMMUNITY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	537 W SUGAR CREEK RD STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-6103
Country	:	US
Telephone Number	:	704-979-8210
Fax Number	:	877-492-8881

Provider Business Practice Location Address
First Line	:	537 W SUGAR CREEK RD STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-6103
Country	:	US
Telephone Number	:	704-979-8210
Fax Number	:	877-492-8881

Authorized Official
Title or Position	:	ADMINISTATOR
Name	:	MR. OKYERE BONNA
Credential	:
Telephone Number	:	704-526-9052

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	02/12/2026

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Directions to “CALVARY COMMUNITY MEDICAL CLINIC ” Practice Location

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