Organization
MECKLENBURG MEDICAL GROUP
Active
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
4525 CAMERON VALLEY PKWY, SUITE 3100, CHARLOTTE, NC 28211-4369
(704) 302-9300
(704) 302-9305
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-9300
(704) 302-9305
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477879260
—
NC
01
—
7705301
NC MEDICAID DME
NC
05
—
89013C0
—
NC
05
—
E08621
—
SC
Enumeration date
04/19/2010
Last updated
08/15/2016
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