Provider Demographics
NPI:1043495419
Name:PSYCHIATRIC AND FORENSIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PSYCHIATRIC AND FORENSIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:704-525-1753
Mailing Address - Street 1:PO BOX 12216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28220-2216
Mailing Address - Country:US
Mailing Address - Phone:704-525-1753
Mailing Address - Fax:704-561-0926
Practice Address - Street 1:1515 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3239
Practice Address - Country:US
Practice Address - Phone:704-525-1753
Practice Address - Fax:704-561-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC173992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902801Medicaid