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653 Bluefield Road Suite F Mooresville NC 28117 | |
| (704) 883-3378 | |
| (704) 883-3228 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 653 Bluefield Road, Mooresville, North Carolina |
| Authorized Official Name and Position | Carla D Johnson (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 7048735661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 896199 Charlotte NC 28289-6199 Ph: (833) 936-1364 | 653 Bluefield Road Suite F Mooresville NC 28117 Ph: (704) 883-3378 |
| NPI Number | 1235711334 |
|---|---|
| Provider Enumeration Date | 04/27/2021 |
| Last Update Date | 06/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235711334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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