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103 Stanly Pkwy Suite B Locust NC 28097-7704 | |
(704) 888-8581 | |
(704) 888-8488 |
Full Name | |
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Speciality | Family Medicine |
Location | 103 Stanly Pkwy, Locust, North Carolina |
Authorized Official Name and Position | Douglas Scott Forth (CEO) |
Authorized Official Contact | 7049838756 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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320 Yadkin St Suite B Albemarle NC 28001-3447 Ph: (704) 982-0639 | 103 Stanly Pkwy Suite B Locust NC 28097-7704 Ph: (704) 888-8581 |
NPI Number | 1073594305 |
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Provider Enumeration Date | 11/14/2005 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1073594305 | NPI | - | NPPES |
89015AE | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |