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823 E King St Kings Mountain NC 28086-3186 | |
| (704) 487-7256 | |
| (704) 487-7258 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 823 E King St, Kings Mountain, North Carolina |
| Authorized Official Name and Position | Daniel L Wiens (SENIOR VICE PRESIDENT OPERATIONS) |
| Authorized Official Contact | 7043550648 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 601884 Charlotte NC 28260-1884 Ph: (704) 487-7256 | 823 E King St Kings Mountain NC 28086-3186 Ph: (704) 487-7256 |
| NPI Number | 1326323239 |
|---|---|
| Provider Enumeration Date | 10/12/2011 |
| Last Update Date | 01/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326323239 | NPI | - | NPPES |
| 5918682 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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