Provider Demographics
NPI:1538651898
Name:MCCANN, ALISON MENZIES
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MENZIES
Last Name:MCCANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-768-9535
Mailing Address - Fax:336-768-4155
Practice Address - Street 1:4622 COUNTRY CLUB RD STE 180
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3770
Practice Address - Country:US
Practice Address - Phone:336-768-9535
Practice Address - Fax:336-768-4155
Is Sole Proprietor?:No
Enumeration Date:2018-06-02
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08144363A00000X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant