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General NPI Number Information
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NPI Number | 1255314134
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Entity Type | Individual
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Provider Name | JOHN LABS PA
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 1900 RANDOLPH RD STE 1016
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City | CHARLOTTE
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State | NC
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Zip | 28207-1117
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Country | US
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Telephone | 704-347-3447
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Fax | 704-347-3440
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Provider Business Mailing Address
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Address Line | PO BOX 1844
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City | BRYSON CITY
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State | NC
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Zip | 28713-1844
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Country | US
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Telephone | 980-270-6770
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Fax | 828-538-4441
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 103861
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License Number State | NC
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