NPIMap

Organization Active NPI

Charlotte Eye Ear Nose & Throat Associates, PA

  • Otolaryngology Physician
  • Mooresville, NC
National Provider Identifier
1366793465
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
CHARLOTTE EYE EAR NOSE & THROAT ASSOCIATES, PA
Practice address
144 Fountain PL
Mooresville, NC 28117-0162
Phone
(704) 658-0595
Fax
(704) 658-0916
NPI assigned
Sep 28, 2012
Last updated
Sep 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Authorized official

Name
Jag S Gill, SCD
Title
Ceo
Phone
(704) 295-3000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X Primary
Facial Plastic Surgery Physician 207YS0123X
Audiologist 231H00000X
Audiologist-Hearing Aid Fitter 237600000X

Addresses

Primary practice location

144 Fountain PL
Mooresville, NC 28117-0162

Mailing address

6035 Fairview Rd
Charlotte, NC 28210-3256
Phone (704) 295-3000

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2122073Charlotte Eye Ear Nose & Throat144 Fountain Place, Mooresville, NC 28117Certificate of waiverNov 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Charlotte Eye Ear Nose an19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Locations

114 Gateway Blvd
Ste B
Mooresville, NC 28117
Phone (704) 658-0720

NPI Registry JSON

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

{
    "created_epoch": "1348790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1366793465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6035 FAIRVIEW RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282103256",
            "telephone_number": "704-295-3000",
            "fax_number": "704-295-3468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 FOUNTAIN PL",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281170162",
            "telephone_number": "704-658-0595",
            "fax_number": "704-658-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE EYE EAR NOSE & THROAT ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-28",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "GILL",
        "authorized_official_first_name": "JAG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-295-3000",
        "authorized_official_credential": "SCD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.