Provider Demographics
NPI:1336725712
Name:INGRAM, KWONE U (MD)
Entity Type:Individual
Prefix:DR
First Name:KWONE
Middle Name:U
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1248
Mailing Address - Country:US
Mailing Address - Phone:704-304-7000
Mailing Address - Fax:704-304-7008
Practice Address - Street 1:1924 ALCOA HWY # U-67
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9350
Practice Address - Fax:865-305-8942
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program