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512 Village Rd Ste 207 Shallotte NC 28470-3409 | |
| (910) 721-4220 | |
| (910) 721-4229 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 512 Village Rd Ste 207, Shallotte, North Carolina |
| Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
| Authorized Official Contact | 7043166081 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: (910) 721-4220 | 512 Village Rd Ste 207 Shallotte NC 28470-3409 Ph: (910) 721-4220 |
| NPI Number | 1568901254 |
|---|---|
| Provider Enumeration Date | 02/15/2017 |
| Last Update Date | 06/12/2024 |
| Certification Date | 06/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568901254 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
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