Individual
DR. BENJAMIN JAMES MISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5815 BLAKENEY PARK DR, SUITE 200B, CHARLOTTE, NC 28277-5731
(704) 316-5080
(704) 316-5085
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
201001144
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5915631
—
NC
05
—
NC1683
—
SC
Enumeration date
06/25/2007
Last updated
10/25/2020
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