Individual
EBONIQUE MOMENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 377-3389
Mailing address
927 EAST BLVD, CHARLOTTE, NC 28203
(704) 377-3389
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2012-01406
NC
207L00000X
Anesthesiology Physician
Primary
84641
GA
207L00000X
Anesthesiology Physician
MD35024
SC
207LP3000X
Pediatric Anesthesiology Physician
002293
GA
Other
Enumeration date
04/20/2007
Last updated
01/15/2020
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