Active NPI
Darryl E Radford Sr., REVEREND
- Community Health Worker
- Charlotte, NC
National Provider Identifier
1902180243
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 1763096
- Practice address
- 4921 Albemarle Rd Ste 204
Charlotte, NC 28205-6654 - Phone
- (704) 536-6167
- Fax
- (704) 536-6515
- NPI assigned
- Oct 5, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 1763096 | OH | Primary |
| Health Educator | 174H00000X | 1763096 | OH |
Addresses
Primary practice location
4921 Albemarle Rd Ste 204
Charlotte, NC 28205-6654
Mailing address
4921 Albemarle Rd Ste 204
Charlotte, NC 28205-6654
Phone (704) 536-6167
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1763096 | OH | MD | Health Educator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1902180243",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4921 ALBEMARLE RD STE 204",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282056654",
"telephone_number": "704-536-6167",
"fax_number": "704-536-6515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4921 ALBEMARLE RD STE 204",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282056654",
"telephone_number": "704-536-6167",
"fax_number": "704-536-6515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADFORD",
"first_name": "DARRYL",
"middle_name": "E",
"name_suffix": "Sr.",
"credential": "REVEREND",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-05",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OH",
"license": "1763096",
"primary": true
},
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": "OH",
"license": "1763096",
"primary": false
}
],
"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 Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.