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Organization

MECKLENBURG MEDICAL GROUP

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
1550 FAULK ST, SUITE 1500, MONROE, NC 28112-5086
(704) 302-9700
(704) 302-9701
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-9700
(704) 302-9701

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5914037
NC
01
7705296
MEDICAID DME
NC
05
NPB352
SC
Enumeration date
12/18/2009
Last updated
08/12/2016
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