Provider Demographics
NPI:1508182361
Name:NEAD MEDICAL PC.
Entity Type:Organization
Organization Name:NEAD MEDICAL PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEWUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-319-9045
Mailing Address - Street 1:10504 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8405
Mailing Address - Country:US
Mailing Address - Phone:704-319-9045
Mailing Address - Fax:704-319-9046
Practice Address - Street 1:10504 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8405
Practice Address - Country:US
Practice Address - Phone:704-319-9045
Practice Address - Fax:704-319-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-01215261QA1903X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain