Fennell, Payton Gregory

Fennell, Payton Gregory is an sole proprietor health care provider with primary practice located at 4741 Randolph Rd , Charlotte NC 28211-2919. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Fennell, Payton Gregory can be contacted via phone (704) 365-6730.

Contact Information

Primary practice address
4741 Randolph Rd Charlotte NC 28211-2919
Phone: (704) 365-6730
Fax: (704) 365-6731
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 200601317 North Carolina
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 200601317 North Carolina

Profile Details

NPI number 1306906086
LBN Legal business name Fennell, Payton Gregory
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 11th, 2006
Last updated Jun 14th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306906086 NPPES
North Carolina MEDICAID 1306906086

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