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NPI Code Detail

MEDICARE: MR. JAMIE MICHAEL ANDREWS PA-C

MEDICARE: MR. JAMIE MICHAEL ANDREWS PA-C
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
1363A00000XPhysician Assistant0010-05386NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00936220OTHERGARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2594836OTHERGAWELLCARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972893543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMIE MICHAEL ANDREWS PA-C
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number : 704-316-3410
Fax Number : 704-316-3420
Provider Business Practice Location Address
First Line : 12611 N COMMUNITY HOUSE RD STE 100
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-3817
Country : US
Telephone Number : 704-316-3410
Fax Number : 704-316-3420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2011
Last Update Date : 07/24/2023

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