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5955 Weddington Rd Wesley Chapel NC 28104-6296 | |
(704) 667-4280 | |
(704) 667-4281 |
Full Name | |
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Speciality | Family Medicine |
Location | 5955 Weddington Rd, Wesley Chapel, North Carolina |
Authorized Official Name and Position | Daniel L Wiens (ADMINISTRATION) |
Authorized Official Contact | 7043550648 |
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) 667-4280 | 5955 Weddington Rd Wesley Chapel NC 28104-6296 Ph: (704) 667-4280 |
NPI Number | 1164770467 |
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Provider Enumeration Date | 08/17/2012 |
Last Update Date | 07/24/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164770467 | NPI | - | NPPES |
5917907 | Medicaid | NC | |
QPB648 | Medicaid | SC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |