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103 Stanly Pkwy Suite A Locust NC 28097-7710 | |
(704) 888-0580 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 103 Stanly Pkwy, Locust, North Carolina |
Authorized Official Name and Position | Thomas Ford Laymon (SVP) |
Authorized Official Contact | 7046310002 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 601888 Charlotte NC 28260-1888 Ph: (704) 888-0580 | 103 Stanly Pkwy Suite A Locust NC 28097-7710 Ph: (704) 888-0580 |
NPI Number | 1619371697 |
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Provider Enumeration Date | 10/20/2014 |
Last Update Date | 08/12/2016 |
Identifier | Type | State | Issuer |
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1619371697 | NPI | - | NPPES |
1619371697 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |