Provider Demographics
NPI:1306458062
Name:MAIR, ASA A
Entity type:Individual
Prefix:MR
First Name:ASA
Middle Name:A
Last Name:MAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:1643 CAMPUS PARK DR STE C
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5588
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10551235Z00000X
NC0010-10896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10551OtherNC BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGISTS AND AUDIOLOGISTS
NC0010-10896OtherNC MEDICAL BOARD (PHYSICIAN ASSISTANT)
1178581OtherNCCPA
14047069OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION