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2711 X Ray Dr Gastonia NC 28054-7491 | |
| (704) 834-2420 | |
| (704) 834-2426 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 2711 X Ray Dr, Gastonia, North Carolina |
| Authorized Official Name and Position | David Michael Oconnor (CFO) |
| Authorized Official Contact | 7048342049 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 744786 Atlanta GA 30374-4786 Ph: (704) 834-2450 | 2711 X Ray Dr Gastonia NC 28054-7491 Ph: (704) 834-2420 |
| NPI Number | 1538340559 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 08/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538340559 | NPI | - | NPPES |
| 890119Y | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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