Organization
DYNAMIC HEALTH MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIXIE WINSLOW (EXECUTIVE ASSISTANT)
(704) 525-6288
Entity
Organization
Contact information
Practice address
4705 SOUTH BLVD, CHARLOTTE, NC 28217
(704) 525-6288
(704) 525-6384
Mailing address
4705 SOUTH BLVD, CHARLOTTE, NC 28217
(704) 525-6288
(704) 525-6384
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NONE
—
Enumeration date
09/06/2018
Last updated
09/06/2018
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