| |
236 Market St Suite 110 Locust NC 28097-9439 | |
(704) 384-9590 | |
(704) 384-9591 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 236 Market St, Locust, 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 |
---|---|
Po Box 60447 Charlotte NC 28260-0447 Ph: (704) 384-9590 | 236 Market St Suite 110 Locust NC 28097-9439 Ph: (704) 384-9590 |
NPI Number | 1114105533 |
---|---|
Provider Enumeration Date | 02/07/2008 |
Last Update Date | 07/09/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114105533 | NPI | - | NPPES |
5909009 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (North Carolina) | Primary |
207R00000X | Internal Medicine | (North Carolina) | Secondary |