Provider Demographics
NPI:1497510184
Name:TRYON MEDICAL PARTNERS, PLLC
Entity Type:Organization
Organization Name:TRYON MEDICAL PARTNERS, PLLC
Other - Org Name:TRYON DIABETES PREVENTION PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN CHIEF OPERATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-495-6970
Mailing Address - Street 1:5960 FAIRVIEW RD STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3113
Mailing Address - Country:US
Mailing Address - Phone:704-918-1934
Mailing Address - Fax:
Practice Address - Street 1:6060 PIEDMONT ROW DR S FL 6
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-3884
Practice Address - Country:US
Practice Address - Phone:704-489-3094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRYON MEDICAL PARTNERS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-21
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty