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Organization

BLUEH IV HEALTH SERVICES PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LA TOYA DAWSON (BILLING DIRECTOR)
(352) 231-7551
Entity
Organization

Contact information

Practice address
9625 DAVID TAYLOR DR, CHARLOTTE, NC 28262-2362
(704) 942-8281
(352) 554-5073
Mailing address
3208 GRANDEUR RD, CHARLOTTE, NC 28269-3217

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
363LA2200X
Adult Health Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1336556414
NC
Enumeration date
08/14/2020
Last updated
09/21/2020
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