Healthcare Provider Details

I. General information

NPI: 1467006536
Provider Name (Legal Business Name): TIMOTHY JERONE TURNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2019
Last Update Date: 07/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5809 HILLCREST CIR
INDIAN TRAIL NC
28079-8652
US

IV. Provider business mailing address

5809 HILLCREST CIR
INDIAN TRAIL NC
28079-8652
US

V. Phone/Fax

Practice location:
  • Phone: 704-719-0999
  • Fax:
Mailing address:
  • Phone: 704-719-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number1141
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: