MEDICARE: WOMENS TRANSITIONAL HEALTHCARE PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	188505	NC
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1477988202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS TRANSITIONAL HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	1977 J N PEASE PL STE 203
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4527
Country	:	US
Telephone Number	:	704-817-8230
Fax Number	:	704-665-5645

Provider Business Practice Location Address
First Line	:	1977 J N PEASE PL STE 203
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4527
Country	:	US
Telephone Number	:	704-817-8230
Fax Number	:	704-665-5645

Authorized Official
Title or Position	:	CEO
Name	:	DR. SAMANTHA GRAVES SUFFREN
Credential	:	M.D.
Telephone Number	:	704-817-8230

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	06/02/2020

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