NPIMap

Organization Active NPI

NC Preventative Medicine and Wellness Clinic, PLLC

  • Obesity Medicine (Family Medicine) Physician
  • Charlotte, NC
National Provider Identifier
1376976878
Registry record updated Aug 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X
Legal business name
NC PREVENTATIVE MEDICINE AND WELLNESS CLINIC, PLLC
Practice address
7940 Williams Pond LN
Suite 150
Charlotte, NC 28277-8766
Phone
(704) 752-7779
Fax
(704) 752-7775
NPI assigned
Aug 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2013

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

Authorized official

Name
Dr. Kathryn Ann Shaw, M.D.
Title
Medical Director/Owner
Phone
(704) 752-7779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obesity Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QB0002X Primary

Addresses

Primary practice location

7940 Williams Pond LN
Suite 150
Charlotte, NC 28277-8766

Mailing address

7940 Williams Pond LN
Suite 150
Charlotte, NC 28277-8766
Phone (704) 752-7779

National Provider Directory

National Provider Directory
Tax ID family
NC Preventative Medicine and Wellness Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1376956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376956800000",
    "number": "1376976878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7940 WILLIAMS POND LN",
            "address_2": "SUITE 150",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282778766",
            "telephone_number": "704-752-7779",
            "fax_number": "704-752-7775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7940 WILLIAMS POND LN",
            "address_2": "SUITE 150",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282778766",
            "telephone_number": "704-752-7779",
            "fax_number": "704-752-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NC PREVENTATIVE MEDICINE AND WELLNESS CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-20",
        "last_updated": "2013-08-20",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "704-752-7779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2013; 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.