Basic Information
| Provider Information | |||||||||
| NPI: | 1477574895 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATTIE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60099 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048017900 | ||||||||
| FaxNumber: | 7048923889 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 GRIFFITH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DAVIDSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280369304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042893024 | ||||||||
| FaxNumber: | 7042261236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 09/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 23368 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | N23368 | 05 | SC | MEDICAID | 8921720 | 05 | NC | MEDICAID |