person
Brent Charles Deatherage, PA-C
Medical Physician Assistant in Charlotte, North Carolina
NPI 1336373257

Brent Charles Deatherage is a Medical Physician Assistant based in Charlotte, NC and is specialized in Medical. Brent Charles Deatherage practices in Charlotte, NC and has the professional credentials of PA-C. The NPI Number for Brent Charles Deatherage is 1336373257 and holds a License No. PA9104956 (North Carolina).

The current practice location address for Brent Charles Deatherage is 1900 Randolph Rd, Charlotte, NC and can be reached out via phone at 704-377-2424 and via fax at 704-377-2687.

Location: 1900 Randolph Rd, Charlotte, NC, 28207-1122
person
Provider Profile Details
NPI Number
1336373257
Provider Name
Brent Charles Deatherage
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1900 Randolph Rd, Charlotte, NC, 28207-1122
Phone Number
704-377-2424
Fax Number
704-377-2687
Provider Enumeration Date
05/06/2009
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1900 Randolph Rd
City
State
Zip
28207-1122
Phone Number
704-377-2424
Fax Number
704-377-2687
person
Provider Business Mailing Address Details
Address
1900 Randolph Rd
City
State
Zip
28207-1122
Phone Number
704-377-2424
Fax Number
704-377-2687
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
0010-03428 (North Carolina)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
License No.
PA9104956 (Florida)
Definition
Definition to come...
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