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Individual

DR. JOHN W. TIDWELL II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2801 RANDOLPH RD, STE 200, CHARLOTTE, NC 28211-1051
(704) 377-5675
(704) 335-8163
Mailing address
2801 RANDOLPH RD, STE 200, CHARLOTTE, NC 28211-1051
(704) 377-5675
(704) 335-8163

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
17907
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8983480
NC
05
N17907
SC
Enumeration date
06/23/2005
Last updated
07/08/2007
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