SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC (NPI# 1144524190) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144524190 |
| Entity Type | Organization |
| Organization Name | SOUTH CHARLOTTE GENERAL AND VASCULAR SURGERY PLLC |
| Practice Address |
10512 Park Rd Suite 111 Charlotte NC 28210-8475 |
| Mailing Address |
10512 Park Rd Ste 111&210 Charlotte NC 28210-8475 |
| Practice Telephone | 7049108380 |
| Practice Fax Number | 7048179980 |
| Mailing Telephone | 7049108380 |
| Mailing Fax Number | 7048179980 |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2019-08-29 |
| Authorized Official Name | DR. JAMES NELSON ANTEZANA (GENERAL AND VASCULAR SURGEON) |
| Authorized Official Telephone | 8034125126 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 2009-00158 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 59-13992 | 05 |
| Street Address |
10512 PARK RD SUITE 111 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28210-8475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184614448 | David N Ugland | Ophthalmology | 10512 Park Rd, Suite 200, Charlotte, NC 28210-8475 | 2005-10-26 |
| 1326414137 | Tammy Faw-severeide | Nurse Practitioner | 10512 Park Rd, Ste 101, Charlotte, NC 28210-8473 | 2015-08-16 |
| 1801289913 | Amanda Linch Dmd & Michael Reimels Dds Pllc | Dentist | 10512 Park Rd, Suite 100, Charlotte, NC 28210-8475 | 2015-03-13 |
| 1184961435 | Kirstyn Lee Vega | Physician Assistant | 10512 Park Rd, Suite 113, Charlotte, NC 28210-8475 | 2013-01-07 |
| 1790033728 | Surgical Specialists of Charlotte, Pa-pineville | Surgery | 10512 Park Rd, Suite 101, Charlotte, NC 28210-8475 | 2012-08-23 |
| 1912278623 | Laurie Lizbeth James | Specialist/Technologist | 10512 Park Rd, Suite 209, Charlotte, NC 28210-8475 | 2012-01-26 |
| 1033480462 | Paul R Steadman | General Practice | 10512 Park Rd, Suite 111, Charlotte, NC 28210-8475 | 2012-01-17 |
| 1194001545 | Amanda Maria Holt | Nurse Practitioner | 10512 Park Rd, Suite 210, Charlotte, NC 28210-8475 | 2011-10-31 |
| 1700110814 | Rachelle M. Eiden | Physician Assistant | 10512 Park Rd, Suite 101, Charlotte, NC 28210-8475 | 2009-09-22 |
| 1356583678 | Cristine Mattis | Nurse Practitioner | 10512 Park Rd, Suite # 113, Charlotte, NC 28210-8475 | 2009-04-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920860 | Rx Care 14 LLC | Pharmacy | 7701 Sharon Lakes Road, Suite H, Charlotte, NC 28210 | 2020-04-10 |
| 1427697622 | David Durant Dinsmore | Nurse Anesthetist, Certified Registered | Atrium Health Pineville, 10628 Park Road, Charlotte, NC 28210 | 2020-01-06 |
| 1790256964 | Tele Phys Inc | Internal Medicine | 10035 Park Center Dr., Ste 100, Charlotte, NC 28210 | 2018-12-16 |
| 1104395896 | Bridgett Williams | Behavior Technician | 7806 Andover Woods Drive, Charlotte, NC 28210 | 2018-11-26 |
| 1053880518 | Low-t Physicians Professional Association | Internal Medicine | 10430 Park Road Suite 100a, Charlotte, NC 28210 | 2018-11-14 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1679066658 | Afc Urgent Care and Family Care of Wnc, Pllc | Clinic/Center | 10102 Johnston Rd, Charlotte, NC 28210 | 2018-06-13 |
| 1346777018 | Hopeway Foundation | Clinic/Center | 1717 Sharon Road West, Charlotte, NC 28210 | 2017-05-12 |
| 1891154688 | Jessie Lee Ogienko | Social Worker | 5960 Fairview Rd Ste 328, Charlotte, NC 28210 | 2016-02-22 |
| 1699151985 | Carolina Complete Psychiatry, Pllc | Physician Assistant | 5950 Fairview Road, Suite 708, Charlotte, NC 28210 | 2015-08-10 |
| Find all providers in zip 28210 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922645571 | Novant Medical Group, Inc. | Surgery | 6324 Fairview Rd Ste 420, Charlotte, NC 28210-3372 | 2019-12-03 |
| 1154806271 | The Cosmetic Concierge, Pllc | Surgery | 325 Arlington Ave Unit B, Charlotte, NC 28203-4574 | 2018-09-25 |
| 1619363538 | William Charles Sherrill IIi | Surgery | 1000 Blythe Blvd Ste 601, Charlotte, NC 28203-5812 | 2015-04-07 |
| 1174968069 | Jonathan Bouchez | Surgery | 1000 Blythe Bvld., Charlotte, NC 28203 | 2013-05-06 |
| 1437475779 | Blair A Wormer | Surgery | 1901 Brunswick Ave Ste 200, Charlotte, NC 28207-1897 | 2010-04-12 |
| 1407039845 | Charles Arthur Hill IIi | Surgery | 325 Hawthorne Ln Ste 100, Charlotte, NC 28204 | 2007-12-07 |
| 1841491370 | Johnnie Lyles | Surgery | 2908 Oak Lake Blvd, Suite 205, Charlotte, NC 28208-7703 | 2007-05-31 |
| 1619000486 | Gordon W Jacobs | Surgery | 14920 Wyndham Oaks Dr, Charlotte, NC 28277-1512 | 2007-03-13 |
| 1750421228 | Sandra Giller | Surgery | 1918 Randolph Rd Ste 130, Charlotte, NC 28207-1107 | 2007-02-07 |
| 1831255009 | Wendell Aubrey Goins | Surgery | 9336 Blakeney Centre Dr, Ste 100b, Charlotte, NC 28277-6666 | 2006-12-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.