Healthcare Provider Details

I. General information

NPI: 1942963392
Provider Name (Legal Business Name): EVERSIDE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDUSTRIAL CT
LENOIR NC
28645-8174
US

IV. Provider business mailing address

4651 CHARLOTTE PARK DR STE 300
CHARLOTTE NC
28217-1916
US

V. Phone/Fax

Practice location:
  • Phone: 866-808-6005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL JOHNSON PATTON
Title or Position: DIRECTOR OF RISK MANAGEMENT
Credential:
Phone: 704-936-5546