Provider Demographics
NPI:1205238466
Name:MCGUIRT, BRITTNEY FOREMAN (PA)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:FOREMAN
Last Name:MCGUIRT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRITTNEY
Other - Middle Name:KATHLEEN
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1300 BAXTER ST
Mailing Address - Street 2:STE 215
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3053
Mailing Address - Country:US
Mailing Address - Phone:704-332-0396
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:2711 RANDOLPH RD
Practice Address - Street 2:BLDG 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2034
Practice Address - Country:US
Practice Address - Phone:704-348-2992
Practice Address - Fax:704-971-0035
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05655363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205238466Medicaid
SC2205PAMedicaid
SC2205PAMedicaid
NC1205238466Medicaid
NCNCQ535CMedicare PIN
NCNCQ535DMedicare PIN