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General NPI Number Information
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NPI Number | 1326862848
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Entity Type | Organization
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Legal Business Name | IREDELL PHYSICIAN NETWORK LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1410 FERN CREEK DR
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City | STATESVILLE
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State | NC
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Zip | 28625-9376
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Country | US
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Telephone | 704-978-2250
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Fax | 704-978-2250
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Provider Business Mailing Address
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Address Line | PO BOX 896199
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City | CHARLOTTE
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State | NC
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Zip | 28289-6199
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Country | US
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Telephone | 833-936-1364
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Fax | 605-942-7505
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CARLA D JOHNSON
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Credential |
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Telephone | 980-434-3803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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