Provider Demographics
NPI:1528320702
Name:MEDICAL ATHLETICS LLC
Entity type:Organization
Organization Name:MEDICAL ATHLETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR EXECUTIVE FOR HEALTHCARE ADM
Authorized Official - Prefix:MS
Authorized Official - First Name:SHADAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:704-557-0132
Mailing Address - Street 1:3020 PROSPERITY CHURCH RD
Mailing Address - Street 2:SUITE I #174
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7197
Mailing Address - Country:US
Mailing Address - Phone:704-557-0132
Mailing Address - Fax:877-284-0039
Practice Address - Street 1:8535 CLIFF CAMERON DR
Practice Address - Street 2:SUITE 116
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5908
Practice Address - Country:US
Practice Address - Phone:704-557-0132
Practice Address - Fax:877-284-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty