Basic Information
| Provider Information | |||||||||
| NPI: | 1356779169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13808 PROFESSIONAL CENTER DR | ||||||||
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| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043774009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2015 RANDOLPH RD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043774009 | ||||||||
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| ProviderEnumerationDate: | 10/15/2013 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | SAMMIS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7043774009 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L003016 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.