Organization
AMITY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEQUEENA SMITH (CREDENTIALING)
(704) 493-5326
Entity
Organization
Contact information
Practice address
6010 E W T HARRIS BLVD, CHARLOTTE, NC 28215-4084
(704) 208-4134
(704) 248-8068
Mailing address
6010 E W T HARRIS BLVD, CHARLOTTE, NC 28215-4084
(704) 208-4134
(704) 248-8068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/28/2018
Last updated
07/31/2024
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