Active NPI
George Henry Dornblazer, M.D.
- Psychiatry Physician
- Charlotte, NC
National Provider Identifier
1932257052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 28853
- Practice address
- 447 South Sharon Amity Road
Suite 245
Charlotte, NC 28211-2922 - Phone
- (704) 342-2577
- Fax
- (704) 333-3102
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 28853 | NC | Primary |
Addresses
Primary practice location
447 South Sharon Amity Road
Suite 245
Charlotte, NC 28211-2922
Mailing address
447 South Sharon Amity Road
Suite 245
Charlotte, NC 28211-2922
Phone (704) 342-2577
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28853 | NC | MD | Clinic Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489708800000",
"number": "1932257052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "447 SOUTH SHARON AMITY ROAD",
"address_2": "SUITE 245",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282112922",
"telephone_number": "704-342-2577",
"fax_number": "704-333-3102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "447 SOUTH SHARON AMITY ROAD",
"address_2": "SUITE 245",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282112922",
"telephone_number": "704-342-2577",
"fax_number": "704-333-3102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DORNBLAZER",
"first_name": "GEORGE",
"middle_name": "HENRY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-08",
"last_updated": "2017-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "28853",
"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 Mar 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.