Provider Demographics
NPI:1700105434
Name:AEROCLINIC NORTH CAROLINA
Entity type:Organization
Organization Name:AEROCLINIC NORTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-996-2630
Mailing Address - Street 1:1745 PHOENIX BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5591
Mailing Address - Country:US
Mailing Address - Phone:770-996-2630
Mailing Address - Fax:770-996-2632
Practice Address - Street 1:5501 JOSH BIRMINGHAM PKWY
Practice Address - Street 2:CHARLOTTE DOUGLAS AIRPORT
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5750
Practice Address - Country:US
Practice Address - Phone:980-216-5100
Practice Address - Fax:980-216-5101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICORP HOLDINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care