Organization
SOUTHEAST RENAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER HUNEYCUTT (PRACTICE ADMINISTRATOR)
(704) 927-1755
Entity
Organization
Contact information
Practice address
2301 W MOREHEAD ST, CHARLOTTE, NC 28208-5178
(704) 333-4217
(704) 927-1767
Mailing address
2301 W MOREHEAD ST, CHARLOTTE, NC 28208-5178
(704) 333-4217
(704) 927-1767
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0109V
BCBS OF NC
NC
05
—
890109V
—
NC
05
—
NPA650
—
SC
Enumeration date
10/24/2006
Last updated
04/20/2008
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