Individual
KEITH LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2701 COLTSGATE RD, #105, CHARLOTTE, NC 28211-3534
(704) 541-1213
(704) 541-4210
Mailing address
7804 FAIRVIEW RD STE C, PMB 302, CHARLOTTE, NC 28226-4999
(704) 541-1213
(704) 541-4210
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
9800612
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891139V
—
NC
05
—
N00612
—
SC
Enumeration date
02/02/2006
Last updated
08/05/2011
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