Provider Demographics
NPI:1003835398
Name:MOHANTY, KATHY GARLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:GARLAND
Last Name:MOHANTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7840
Mailing Address - Fax:704-384-7830
Practice Address - Street 1:6324 FAIRVIEW RD STE 350
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-0095
Practice Address - Country:US
Practice Address - Phone:704-384-8600
Practice Address - Fax:704-384-8610
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129NCMedicaid
SCN0074CMedicaid
NC129NCOtherBCBS PROVIDER #
SCN0074CMedicaid