Provider Demographics
NPI:1235351867
Name:HUBBARD, JEREMY SLADE (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:SLADE
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEREMY
Other - Middle Name:SLADE
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 W.T. HARRIS BLCD. EAST SUITE 5201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-547-1495
Mailing Address - Fax:704-547-1861
Practice Address - Street 1:101 W.T. HARRIS BLVD. EAST SUITE 5201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-7140
Practice Address - Country:US
Practice Address - Phone:704-547-1495
Practice Address - Fax:704-547-1861
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200701727208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1235351867OtherMEDCOST
SC1352181OtherCIGNA
SC379744Medicaid
SC379744Medicaid
NC1235351867OtherATLANTIC INTEGRATED HEALTH