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3845 South New Hope Road Gastonia NC 28056-8439 | |
| (704) 824-9119 | |
| (704) 824-2401 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 3845 South New Hope Road, Gastonia, North Carolina |
| Authorized Official Name and Position | Kenneth David Burgess (OWNER/ PRESIDENT) |
| Authorized Official Contact | 7048249119 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 551178 Gastonia NC 28055-1178 Ph: (704) 824-9119 | 3845 South New Hope Road Gastonia NC 28056-8439 Ph: (704) 824-9119 |
| NPI Number | 1992974042 |
|---|---|
| Provider Enumeration Date | 02/22/2008 |
| Last Update Date | 07/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992974042 | NPI | - | NPPES |
| 8919982 | Medicaid | NC | |
| 19982 | Other | NC | BCBS |
| P00297412 | Other | NC | PALMETTO GBA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 32655 (North Carolina) | Primary |
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