Provider Demographics
NPI:1720019110
Name:AA MANAGEMENT CORP
Entity Type:Organization
Organization Name:AA MANAGEMENT CORP
Other - Org Name:AA PRIMECARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-333-5606
Mailing Address - Street 1:401 HAWTHORNE LN
Mailing Address - Street 2:SUITE 110/121
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2484
Mailing Address - Country:US
Mailing Address - Phone:704-333-5606
Mailing Address - Fax:704-333-5611
Practice Address - Street 1:1401 E 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2407
Practice Address - Country:US
Practice Address - Phone:704-333-5606
Practice Address - Fax:704-333-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905847Medicaid
NC5905847Medicaid