MEDICARE: MAGNUSSON CLINIC 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1821936535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNUSSON CLINIC PLLC

Provider Business Mailing Address
First Line	:	12749 NETHERHALL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12749 NETHERHALL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8405
Country	:	US
Telephone Number	:	704-412-8297
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREAS MAGNUSSON
Credential	:	MD
Telephone Number	:	704-412-8297

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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