Basic Information
Provider Information
NPI: 1174001325
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LINDSEY
FirstName: ALEXANDRIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1401 E 7TH ST
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282046300
CountryCode: US
TelephoneNumber: 7047088314
FaxNumber: 7047088315
Practice Location
Address1: 2301 CROWNPOINT EXECUTIVE DR STE E
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282276725
CountryCode: US
TelephoneNumber: 7047088314
FaxNumber: 7047088315
Other Information
ProviderEnumerationDate: 07/31/2018
LastUpdateDate: 03/18/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-18-61751NCY193400000X SINGLE SPECIALTY GROUP   

No ID Information.


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