Healthcare Provider Details

I. General information

NPI: 1528124245
Provider Name (Legal Business Name): LAUREL OB GYN ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N WENDOVER RD
CHARLOTTE NC
28211-1064
US

IV. Provider business mailing address

431 N WENDOVER RD
CHARLOTTE NC
28211-1064
US

V. Phone/Fax

Practice location:
  • Phone: 704-338-9752
  • Fax: 704-338-9691
Mailing address:
  • Phone: 704-338-9752
  • Fax: 704-338-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHRYN JOHNSON STEPHENS
Title or Position: OWNER
Credential: M.D.
Phone: 704-338-9752