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General NPI Number Information
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NPI Number | 1053690560
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Entity Type | Organization
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Legal Business Name | LAKE NORMAN EMERGENCY MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 171 FAIRVIEW RD
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City | MOORESVILLE
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State | NC
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Zip | 28117-9500
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Country | US
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Telephone | 704-660-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 319 SPRINGWOOD DR NE
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City | VALDESE
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State | NC
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Zip | 28690-8710
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Country | US
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Telephone | 828-879-8419
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DAVID PARKER
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Credential |
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Telephone | 828-879-8419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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