Provider Demographics
NPI:1497785604
Name:JARRATT, MIKELL J (MD)
Entity Type:Individual
Prefix:
First Name:MIKELL
Middle Name:J
Last Name:JARRATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7489
Mailing Address - Country:US
Mailing Address - Phone:704-867-2341
Mailing Address - Fax:704-867-9019
Practice Address - Street 1:1021 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7489
Practice Address - Country:US
Practice Address - Phone:704-867-2341
Practice Address - Fax:704-867-9019
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00850207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945833Medicaid
SCN00850Medicaid
NC110125035OtherRAILROAD MEDICARE
NC45833OtherBCBSNC PROVIDER #
NC2202741Medicare ID - Type Unspecified
NC45833OtherBCBSNC PROVIDER #