MEDICARE: ALTAVERA BEHAVIORAL HEALTH PC

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	2084P0802X	Addiction Psychiatry Physician

General Provider Information

NPI Number	:	1487594271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTAVERA BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	432 COPPERFIELD BLVD NE STE 200
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2427
Country	:	US
Telephone Number	:	704-906-9573
Fax Number	:

Provider Business Practice Location Address
First Line	:	432 COPPERFIELD BLVD NE STE 200
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2427
Country	:	US
Telephone Number	:	704-906-9573
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	JONATHAN KEITH STOUDMIRE
Credential	:	MD
Telephone Number	:	704-906-9573

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	04/07/2026

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