Organization
CHARLOTTE MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS FORD LAYMON (SENIOR VICE PRESIDENT)
(704) 631-0002
Entity
Organization
Contact information
Practice address
10545 BLAIR ROAD, SUITE 2100, MINT HILL, NC 28227-2804
(704) 863-9500
(704) 355-5188
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 863-9500
(704) 355-5188
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5908921
—
NC
01
—
7705275
NC MEDICAID DME
NC
05
—
E04411
—
SC
Enumeration date
03/29/2010
Last updated
08/10/2016
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