Individual
SHAUN GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
416 MCCULLOUGH DR STE 210, CHARLOTTE, NC 28262-4393
(919) 806-6365
Mailing address
416 MCCULLOUGH DR STE 210, CHARLOTTE, NC 28262-4393
(919) 806-6365
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
DURHQTJHFR091029
NC
Other
Enumeration date
10/02/2024
Last updated
10/02/2024
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