Genesis ENT & Plastic Surgery, PLLC

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

9700531 Issued in NC

Legal business name

GENESIS ENT & PLASTIC SURGERY, PLLC

Practice address

14835 John J Delaney Dr
Suite 210
Charlotte, NC 28277-2738

Phone

(704) 544-1300

Fax

(704) 544-2765

NPI assigned

Jun 11, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Henry Ford

Title

Administrator

Phone

(704) 544-1300

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366484958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14835 JOHN J DELANEY DR",
            "address_2": "SUITE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772738",
            "telephone_number": "704-544-1300",
            "fax_number": "704-544-2765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14835 JOHN J DELANEY DR",
            "address_2": "SUITE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772738",
            "telephone_number": "704-544-1300",
            "fax_number": "704-544-2765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS ENT & PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-544-1300"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NC",
            "license": "9700531",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191722",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Generational Health
• Generational Health
• Generational Health of North Carolina
• Generations of Health Homecare LLC
• Genesis Clincal Services
• Genesis Eye Center
• Genesis Finance Corporation
• Genesis Home Health Agency
• Genesis of Carolinas Home Care, LLC
• Genesis of Carolinas Home Care, LLC

• Otolaryngology/Facial Plastic Surgery Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Otolaryngology/Facial Plastic Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.