Provider Demographics
NPI:1013550169
Name:MDASPECT SC
Entity Type:Organization
Organization Name:MDASPECT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:919-210-6775
Mailing Address - Street 1:PO BOX 20083
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-0027
Mailing Address - Country:US
Mailing Address - Phone:919-210-6775
Mailing Address - Fax:828-327-2597
Practice Address - Street 1:913 BOWMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3235
Practice Address - Country:US
Practice Address - Phone:919-210-6775
Practice Address - Fax:828-327-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty