Organization Active NPI

Mecklenburg Medical Group

Doing business as Mecklenburg Medical Group (MMG)

Dermatology Physician
Charlotte, NC

National Provider Identifier

1427374487

Registry record updated Aug 31, 2020

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Charlotte, NC
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Dermatology PhysicianTaxonomy code 207N00000X
Legal business name: MECKLENBURG MEDICAL GROUP
Doing business as: Mecklenburg Medical Group (MMG)
Practice address: 3030 Randolph Rd
Ste 200
Charlotte, NC 28211-1368
Phone: (704) 302-8200
NPI assigned: Apr 15, 2010
Last updated: Aug 31, 2020By the provider in NPPES
Organization subpart: Yes
Parent organization: MECKLENBURG MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Authorized official

Name: Thomas Laymon
Title: Senior Vice President
Phone: (704) 446-8250

Specialties & licenses 13

Specialty (taxonomy)	Code	Primary
Dermatology Physician	207N00000X	Primary
Internal Medicine Physician	207R00000X
Cardiovascular Disease Physician	207RC0000X
Endocrinology, Diabetes & Metabolism Physician	207RE0101X
Gastroenterology Physician	207RG0100X
Geriatric Medicine (Internal Medicine) Physician	207RG0300X
Hematology & Oncology Physician	207RH0003X
Infectious Disease Physician	207RI0200X
Pulmonary Disease Physician	207RP1001X
Rheumatology Physician	207RR0500X
Medical Oncology Physician	207RX0202X
Obesity Medicine (Internal Medicine) Physician	207RB0002X
Sleep Medicine (Internal Medicine) Physician	207RS0012X

Addresses

Primary practice location

3030 Randolph Rd
Ste 200
Charlotte, NC 28211-1368

Mailing address

PO Box 19305
Charlotte, NC 28219-9305
Phone (704) 631-0002

Other names 1

Mecklenburg Medical Group (MMG) Doing business as

National Provider Directory

Part of: Mecklenburg Medical Group

NPI Registry JSON

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

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598832000000",
    "number": "1427374487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305",
            "telephone_number": "704-631-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 RANDOLPH RD",
            "address_2": "STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111368",
            "telephone_number": "704-302-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECKLENBURG MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MECKLENBURG MEDICAL GROUP",
        "enumeration_date": "2010-04-15",
        "last_updated": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "LAYMON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "704-446-8250"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mecklenburg Medical Group (MMG)",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mecklenburg Medical Group (MMG)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 31, 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.