Provider Demographics
NPI:1164143996
Name:MECKLENBURG COUNTY
Entity Type:Organization
Organization Name:MECKLENBURG COUNTY
Other - Org Name:MECKLENBURG COUNTY HEALTH DEPT - NORTHEAST CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYNARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-579-0671
Mailing Address - Street 1:249 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1003
Mailing Address - Country:US
Mailing Address - Phone:980-314-9126
Mailing Address - Fax:
Practice Address - Street 1:430 STITT ROAD
Practice Address - Street 2:MECKLENBURG COUNTY PUBLIC HEALTH DEPARTMENT
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213
Practice Address - Country:US
Practice Address - Phone:704-336-6400
Practice Address - Fax:704-432-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic PharmacyGroup - Multi-Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1972645422OtherNPI