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19485 Old Jetton Road Suite 100 Cornelius NC 28031-6583 | |
(704) 316-5170 | |
(704) 316-5172 |
Full Name | |
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Speciality | Family Medicine |
Location | 19485 Old Jetton Road, Cornelius, North Carolina |
Authorized Official Name and Position | Leea Jeanine Walton (RCS MANAGER) |
Authorized Official Contact | 7043166081 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 60447 Charlotte NC 28260-0447 Ph: (704) 316-5170 | 19485 Old Jetton Road Suite 100 Cornelius NC 28031-6583 Ph: (704) 316-5170 |
NPI Number | 1255709432 |
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Provider Enumeration Date | 09/04/2015 |
Last Update Date | 07/09/2024 |
Identifier | Type | State | Issuer |
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1255709432 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Diabetic Special Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19900 W Catawba Ave, Cornelius, NC 28031 Phone: 704-895-8478 Fax: 704-895-8478 | |
Innovative Healthcare Management Provider Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 19401 Old Jetton Rd Ste 100, Cornelius, NC 28031 Phone: 704-473-5263 Fax: 704-731-0961 | |