Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Sep 3, 2016
License(s)
001006467 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 6909 PROSPERITY CHURCH RD | Huntersville, NC 28078-6698 | 704-316-2050 |
| MAILING | PO BOX 60447 | Charlotte, NC 28260-0447 | 704-316-2050 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.