Basic Information
| Provider Information | |||||||||
| NPI: | 1770807141 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OCCUPATIONAL HEALTH CENTERS OF NORTH CAROLINA, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONCENTRA MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 82730 | ||||||||
| Address2: | |||||||||
| City: | HAPEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303540730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006860468 | ||||||||
| FaxNumber: | 2147754502 | ||||||||
| Practice Location | |||||||||
| Address1: | 4104 SURLES COURTS SUITE 11 | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199411911 | ||||||||
| FaxNumber: | 2177754502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2010 | ||||||||
| LastUpdateDate: | 10/26/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP/CHIEF OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9723648000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.