Provider Demographics
NPI:1356222483
Name:CALVARY COMMUNITY MEDICAL CLINIC
Entity type:Organization
Organization Name:CALVARY COMMUNITY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OKYERE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-526-9052
Mailing Address - Street 1:537 W SUGAR CREEK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6103
Mailing Address - Country:US
Mailing Address - Phone:704-979-8210
Mailing Address - Fax:877-492-8881
Practice Address - Street 1:537 W SUGAR CREEK RD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6103
Practice Address - Country:US
Practice Address - Phone:704-979-8210
Practice Address - Fax:877-492-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty