Individual
DR. PAYTON GREGORY FENNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
4741 RANDOLPH RD, CHARLOTTE, NC 28211-2919
(704) 365-6730
(704) 365-6731
Mailing address
52 12TH AVE NE, HICKORY, NC 28601-2798
(828) 485-3004
(828) 328-4049
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
200601317
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
200601317
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306906086
—
NC
Enumeration date
12/11/2006
Last updated
06/14/2021
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