Basic Information
| Provider Information | |||||||||
| NPI: | 1306458062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAIR | ||||||||
| FirstName: | ASA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953643 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2020 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 10551 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 363A00000X | 0010-10896 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 10551 | 01 | NC | NC BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS | OTHER | 0010-10896 | 01 | NC | NC MEDICAL BOARD (PHYSICIAN ASSISTANT) | OTHER | 1178581 | 01 | NCCPA | OTHER | 14047069 | 01 | AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION | OTHER |