Provider Demographics
NPI:1043955719
Name:CHARLOTTE URGENT CARE PROVIDERS, P.C.
Entity Type:Organization
Organization Name:CHARLOTTE URGENT CARE PROVIDERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MALAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-709-1171
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-376-7600
Mailing Address - Fax:
Practice Address - Street 1:1431 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4211
Practice Address - Country:US
Practice Address - Phone:704-709-1171
Practice Address - Fax:704-709-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care