Provider Demographics
NPI:1164982518
Name:HYSONG, ALEXANDER AMIR
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:AMIR
Last Name:HYSONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MOREHEAD MEDICAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2966
Mailing Address - Country:US
Mailing Address - Phone:704-446-2772
Mailing Address - Fax:704-355-2467
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2966
Practice Address - Country:US
Practice Address - Phone:704-446-2772
Practice Address - Fax:704-355-2467
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250269207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery