| NPI | 1881144590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA JARVIS MICOLUCCI CEO 704-953-4890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 261QP2300X Clinic/Center, Primary Care | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2024-08-19 |