Provider Demographics
NPI:1669502647
Name:SOUTHEAST BARIATRICS
Entity Type:Organization
Organization Name:SOUTHEAST BARIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:VOELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-347-4144
Mailing Address - Street 1:2300 RANDOLPH RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1586
Mailing Address - Country:US
Mailing Address - Phone:704-347-4144
Mailing Address - Fax:704-347-4148
Practice Address - Street 1:2300 RANDOLPH RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1586
Practice Address - Country:US
Practice Address - Phone:704-347-4144
Practice Address - Fax:704-347-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC132GXOtherBCBS
NC89132GXMedicaid
NC2331717Medicare PIN
NC89132GXMedicaid