Basic Information
| Provider Information | |||||||||
| NPI: | 1679898548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARKY | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | HALL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7825 BALLANTYNE COMMONS PKWY STE 150 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282773175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043163070 | ||||||||
| FaxNumber: | 7043163071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2010 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Q6652 | TX | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 2019-00191 | NC | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 362033801 | 05 | TX | MEDICAID | 8GA358 | 01 | TX | BCBS | OTHER | 8GA344 | 01 | TX | BCBS | OTHER |