Healthcare Provider Details

I. General information

NPI: 1952977563
Provider Name (Legal Business Name): ATRIUM HEALTH HUNTERSVILLE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 01/19/2024
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16455 STATESVILLE RD STE 100
HUNTERSVILLE NC
28078-7137
US

IV. Provider business mailing address

16455 STATESVILLE RD STE 100
HUNTERSVILLE NC
28078-7137
US

V. Phone/Fax

Practice location:
  • Phone: 704-801-1701
  • Fax: 704-987-8403
Mailing address:
  • Phone: 704-801-1701
  • Fax: 704-987-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN LOUISE WILDASIN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 704-801-1701