Basic Information
| Provider Information | |||||||||
| NPI: | 1851548655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2015 RANDOLPH RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043774009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2015 RANDOLPH RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043774009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 08/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAMMIS | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7043774009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 34C001148 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.