| Novant Health Lakeside Primary Care | |
|
7752 Gateway Ln Nw Suite 100 Concord NC 28027-4421 | |
| (704) 316-4950 | |
| (704) 316-4951 |
| Full Name | Novant Health Lakeside Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 7752 Gateway Ln Nw, Concord, 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 |
|---|---|
| Novant Health Lakeside Primary Care Po Box 60447 Charlotte NC 28260-0447 Ph: (704) 316-4950 | Novant Health Lakeside Primary Care 7752 Gateway Ln Nw Suite 100 Concord NC 28027-4421 Ph: (704) 316-4950 |
| NPI Number | 1962582023 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 07/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962582023 | NPI | - | NPPES |
| 018TT | Other | NC | BCBS-NC |
| GPB795 | Medicaid | SC | |
| 5905550 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (North Carolina) | Primary |
| 207R00000X | Internal Medicine | (North Carolina) | Secondary |
| 208000000X | Pediatrics | (North Carolina) | Secondary |
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