MEDICARE: EBONY NICOLE PARSON M.D.

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	207V00000X	Obstetrics & Gynecology Physician	2015-00585	NC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207V00000X	Obstetrics & Gynecology Physician	201500585	NC

General Provider Information

NPI Number	:	1588950729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY NICOLE PARSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-246-1846
Fax Number	:	704-246-1462

Provider Business Practice Location Address
First Line	:	7006 SHANNON WILLOW RD STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1318
Country	:	US
Telephone Number	:	980-960-0526
Fax Number	:	980-207-1386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	03/25/2025

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