MEDICARE: DR. JOSHUA COLE MCKINNON 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	207Q00000X	Family Medicine Physician	2013-00986	NC
2	207Q00000X	Family Medicine Physician	11015589A	IN
3	207R00000X	Internal Medicine Physician	11015589A	IN
4	208M00000X	Hospitalist Physician	2013-00986	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801114343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA COLE MCKINNON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-718-8383
Fax Number	:	336-718-9622

Provider Business Practice Location Address
First Line	:	7130 VILLAGE MEDICAL CIR
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8004
Country	:	US
Telephone Number	:	336-893-2420
Fax Number	:	336-893-2431

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

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	10/25/2020

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