Provider Demographics
NPI:1528700689
Name:MATHIS, ERIC STUART (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:STUART
Last Name:MATHIS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:
Practice Address - Street 1:2093 HENRY TECKLENBURG DR STE 202E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5783
Practice Address - Country:US
Practice Address - Phone:843-958-2590
Practice Address - Fax:843-402-1972
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC26076363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty