| NPI | 1649679192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON K VANDALE Billing Manager 704-262-3833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200700071) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200700071) |
| 208D00000X General Practice (Licence: NC 200700071) | |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |