Organization
CHARLOTTE SPORTS MEDICINE INSTITUTE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN J. PAUL M.D. (OWNER)
(704) 509-6427
Entity
Organization
Contact information
Practice address
10616 METROMONT PKWY, SUITE 106, CHARLOTTE, NC 28269-7656
(704) 509-6427
(704) 509-6964
Mailing address
10616 METROMONT PKWY, SUITE 106, CHARLOTTE, NC 28269-7656
(704) 509-6427
(704) 509-6964
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
009700704
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1051M
BCBS
NC
05
—
891051M
—
NC
Enumeration date
03/31/2009
Last updated
12/08/2014
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