Organization
CHARLOTTE DIETITIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CORRIE DARCY THOMAS MS, RD, LD/N (OWNER)
(561) 603-1779
Entity
Organization
Contact information
Practice address
1212 MANN DR STE 100, MATTHEWS, NC 28105-5511
(561) 603-1779
(704) 839-2335
Mailing address
2643 BRIGHTMOOR RIDGE DR, MATTHEWS, NC 28105-2433
(561) 603-1779
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922351469
BLUE CROSS BLUE SHIELD OF NORTH CAROLINA
—
Enumeration date
10/04/2019
Last updated
10/07/2019
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