Provider Demographics
NPI:1063257210
Name:CHARLOTTE FAMILY CLINIC
Entity type:Organization
Organization Name:CHARLOTTE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-480-4825
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TX
Mailing Address - Zip Code:78011-0963
Mailing Address - Country:US
Mailing Address - Phone:830-480-4825
Mailing Address - Fax:
Practice Address - Street 1:14142 WFM 140
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:TX
Practice Address - Zip Code:78011
Practice Address - Country:US
Practice Address - Phone:830-480-4825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty