Provider Demographics
NPI:1154490100
Name:EPPS, EARL JOSEPH JR (ND)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:JOSEPH
Last Name:EPPS
Suffix:JR
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S TORRENCE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2928
Mailing Address - Country:US
Mailing Address - Phone:704-377-6737
Mailing Address - Fax:704-377-7107
Practice Address - Street 1:700 S TORRENCE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2928
Practice Address - Country:US
Practice Address - Phone:704-377-6737
Practice Address - Fax:704-377-7107
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930704Medicaid
NC30704OtherBLUE CROSS BLUE SHEILD
NC202258Medicare ID - Type Unspecified
NC30704OtherBLUE CROSS BLUE SHEILD