Healthcare Provider Details

I. General information

NPI: 1871308890
Provider Name (Legal Business Name): PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 NORTHRIDGE PARK DR
RURAL HALL NC
27099-0001
US

IV. Provider business mailing address

5500 MARYLAND WAY STE 120
BRENTWOOD TN
37027-4993
US

V. Phone/Fax

Practice location:
  • Phone: 336-519-6445
  • Fax: 336-519-0660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN B LEIZMAN
Title or Position: PRESIDENT
Credential:
Phone: 615-468-6270