| Dtna - Gastonia Occ | |
|
1400 Tulip Dr Gastonia NC 28052-1873 | |
| (704) 868-5703 | |
| (704) 868-5787 |
| Full Name | Dtna - Gastonia Occ |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1400 Tulip Dr, Gastonia, North Carolina |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dtna - Gastonia Occ 5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | Dtna - Gastonia Occ 1400 Tulip Dr Gastonia NC 28052-1873 Ph: (704) 868-5703 |
| NPI Number | 1568137719 |
|---|---|
| Provider Enumeration Date | 08/10/2021 |
| Last Update Date | 08/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568137719 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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