Provider Demographics
NPI:1740515196
Name:A&W EXPRESS INC.
Entity type:Organization
Organization Name:A&W EXPRESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-488-7784
Mailing Address - Street 1:4623 POTTERS GLEN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7351
Mailing Address - Country:US
Mailing Address - Phone:704-488-7784
Mailing Address - Fax:704-599-5876
Practice Address - Street 1:4623 POTTERS GLEN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7351
Practice Address - Country:US
Practice Address - Phone:704-488-7784
Practice Address - Fax:704-599-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21068639332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies