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Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K. GARDNER (VP OF FINANCE)
(704) 384-9094
Entity
Organization
Contact information
Practice address
1918 RANDOLPH RD, SUITE 175, CHARLOTTE, NC 28207-1100
(704) 316-1050
(704) 316-1051
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-1050
(704) 316-1051
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011A9
BCBS NC
NC
05
—
89011A9
—
NC
05
—
NPA901
—
SC
Enumeration date
05/11/2006
Last updated
05/04/2011
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