Provider Demographics
NPI:1699442400
Name:WEBBER, GARDNER (NCCPSS, AFPA HNC)
Entity type:Individual
Prefix:
First Name:GARDNER
Middle Name:
Last Name:WEBBER
Suffix:
Gender:M
Credentials:NCCPSS, AFPA HNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15836 WHITE ST UNIT 14-103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-0215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15836 WHITE ST UNIT 14-103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-0215
Practice Address - Country:US
Practice Address - Phone:704-737-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
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