| Southern Mobile Medical Group PA | |
|
5804 Monroe Rd Ste C Charlotte NC 28212-6183 | |
| (385) 499-5535 | |
| Not Available |
| Full Name | Southern Mobile Medical Group PA |
|---|---|
| Speciality | General Practice |
| Location | 5804 Monroe Rd Ste C, Charlotte, North Carolina |
| Authorized Official Name and Position | Zachary Mandler (DIRECTOR OF CONTRACTING) |
| Authorized Official Contact | 3058907738 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Mobile Medical Group PA Po Box 3044 Houston TX 77253-3044 Ph: (385) 499-5535 | Southern Mobile Medical Group PA 5804 Monroe Rd Ste C Charlotte NC 28212-6183 Ph: (385) 499-5535 |
| NPI Number | 1730903675 |
|---|---|
| Provider Enumeration Date | 11/07/2024 |
| Last Update Date | 02/24/2026 |
| Certification Date | 02/24/2026 |
| Medicare PECOS PAC ID | 8820528508 |
|---|---|
| Medicare Enrollment ID | O20250211000684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730903675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (NU) | Primary |
| Provider Name | Yasmin Ahmed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033322326 PECOS PAC ID: 1759277700 Enrollment ID: I20150310001536 |
| Provider Name | Heather Dyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528500444 PECOS PAC ID: 3072894096 Enrollment ID: I20170106000664 |
| Provider Name | Cecelia M Glaubitz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649814955 PECOS PAC ID: 5597194886 Enrollment ID: I20200408001043 |
| Provider Name | Bhumika Nilay Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720661143 PECOS PAC ID: 5890187413 Enrollment ID: I20220111002318 |
| Provider Name | Myrna Cassion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275285660 PECOS PAC ID: 6002293008 Enrollment ID: I20220512001842 |
| Provider Name | Belinda J Cohen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598480592 PECOS PAC ID: 5294103313 Enrollment ID: I20221122000501 |
| Provider Name | Megan Wlodarczyk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295418010 PECOS PAC ID: 8224485552 Enrollment ID: I20231108002264 |
| Provider Name | Elliana Juliet Yeager |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1639916810 PECOS PAC ID: 3971036419 Enrollment ID: I20241023001085 |
| Provider Name | Tameki Lavette Mongo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770319691 PECOS PAC ID: 2769915040 Enrollment ID: I20241024002801 |
| Provider Name | Shenita Colson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164262119 PECOS PAC ID: 4486187093 Enrollment ID: I20241104001596 |
| Provider Name | Denise Rolle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427866201 PECOS PAC ID: 2961925060 Enrollment ID: I20250331000402 |
| Provider Name | Nikita Blakeney-williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770382533 PECOS PAC ID: 5799941266 Enrollment ID: I20250514003046 |
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