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17810 Statesville Rd Suite 311 Cornelius NC 28031-8148 | |
(704) 655-6300 | |
(704) 655-7997 |
Full Name | |
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Speciality | Pediatrics |
Location | 17810 Statesville Rd, Cornelius, North Carolina |
Authorized Official Name and Position | Shepard Sewell Averitt (ADMINISTRATOR) |
Authorized Official Contact | 7042162020 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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129 Woodson St Salisbury NC 28144-3255 Ph: (704) 636-5576 | 17810 Statesville Rd Suite 311 Cornelius NC 28031-8148 Ph: (704) 655-6300 |
NPI Number | 1124356019 |
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Provider Enumeration Date | 12/03/2009 |
Last Update Date | 12/03/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124356019 | NPI | - | NPPES |
8902597 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (North Carolina) | Secondary |
208000000X | Pediatrics | (North Carolina) | 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 | |