Provider Demographics
NPI:1295268290
Name:SCHOLAR ATHLETICS
Entity type:Organization
Organization Name:SCHOLAR ATHLETICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:NIX
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:704-594-1307
Mailing Address - Street 1:4348 TRIPLE CROWN DR SW STE A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8925
Mailing Address - Country:US
Mailing Address - Phone:704-594-1307
Mailing Address - Fax:
Practice Address - Street 1:4348 TRIPLE CROWN DR SW STE A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8925
Practice Address - Country:US
Practice Address - Phone:704-594-1307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health